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COPYRIGHT DEPOSIT 



LESSONS ON 

TUBERCULOSIS 

AND CONSUMPTION 

For the Household 

SHOWING 

How to Prevent Tuberculosis 

How to Recognize Its First Symptoms 

How to Win Back Health 



By 
CHARLES E. ATKINSON, M.D., 

Recently Medical Director of the Seymour Sanatorium for Diseases 
of the Throat and Lungs, Banning, California; formerly Member 
of the Resident Medical Staff at the Pottenger Sanatorium for 
Diseases of the Throat and Lungs, Monrovia, Cal. ; previously 
Attending Physician and Instructor in the Medical Clinic of the 
Graves Memorial Dispensary, Los Angeles Medical Department of 
the University of California; Member of the National Tuberculo- 
sis Association; Fellow of the American Medical Association, etc. 



Illustrated 




FUNK & WAGNALLS COMPANY 

New York and London 
1922 



J\1 



%> 



Copyright, 1922, by 

FUNK & WAGINTALLS COMPANY 

[Printed in the United States of America] 

Published in January, 1922 



Copyright Under the Articles of the Copyright Convention 

of the Pan-American Republics and the 

United States, August 11, 1910. 



FfcB -2 r922 
©CiA65450.4 

<a/1& j 






CONTENTS 

LESSON PAGE 

JREWOED 9 

ilimpses of Many Important Matters . . 15 

How Tuberculosis is Spread . J7 

. How to Prevent Tuberculosis .... 55 

V If the Chest Had a Window .... 82 

V How Tuberculosis May Be Recognized . . 99 
VI You and Your Physician 135 

VII Planning Your Recovery 154 

VIII How Nature Heals 174 

IX On Rest and Exercise 188 

X The Secret of Eating to Win ... 222 

XI The Elixir of Health, Fresh Air— Its 

Use and Abuse 255 

XII The Truth About Climate 286 

XIII Hints on Nursing and Suggestions for 
the Relief of Distressing Symptoms . 336 

XIV When Blue Days Come 400 

XV Special Methods of Treatment and 

Surgical Measures 425 

XVI And Afterwards 451 

Index 461 



LIST OF ILLUSTRATIONS 



Mining for Health 

Tubercle Bacilli and White Corpuscles 

Diagram of Breathing Apparatus and 
Lymphatic System 

How Tuberculosis Begins 

Can You Tell Which Man Has 
Tuberculosis ? 

Illustrating the Healing of 
Tuberculosis . 

On the Road to Health 

Making Haste Slowly but 

In a Danger Period . 

Taking a Constitutional 

Old and New Rations 

Where the Burro Does the Work 

Contrasting Curtain Types 

An Attractive Combination 

A Double Roof Over the Sleeping 
Porch 



Surely 



Curtains That Roll at the Bottom 

A Screened-in Sun Deck 

Open Air Sleeping Room Above, 
Loggia Below 

Striking Contrasts 

Under the Quartz Light (Alpine 
Sun Lamp) 

Applying Sunlight in the Throat 



Frontispiece 
facing page 24 



40 

88 

120 

176 
192 
192 
208 
208 
248 
256 
272 
296 

296 
304 
304 

344 
376 

376 
432 



FOREWORD 

ALL who have given much thought to the study of 
tuberculosis have seen that many people have 
hardly a casual or speaking acquaintance with the sub- 
ject. They have realized that lack of knowledge and 
misinformation have been responsible for numberless 
unnecessary and disastrous mistakes; that to-day the 
deaths from tuberculosis would be few indeed if all were 
acquainted with the main facts regarding the white 
plague. Only those who have themselves been "through 
the mill," or those who, for one reason or another, 
have been brought into intimate contact with a number 
of afflicted persons, can thoroughly appreciate how many 
there are who discover the truth so late that they are 
forced to spend years of effort and a fortune in the 
search for health — a search which, after all, in many 
cases, proves fruitless! And what countless thousands 
have been totally misdirected, to fall into pitfall after 
pitfall ere they finally won ! Only those who have them- 
selves made costly mistakes (and this means the majority 
of those afflicted with tuberculosis) can fully appreciate 
how easy it is to go astray — how hard it is to discover 
and keep on the road to victory. 

Because I, too, have "played the game," because for 
years I have given the greater part of my time and 
attention to tuberculosis, I feel that I am able to put 
myself in the place of the "other fellow" who realizes 
that things are not quite right with him, but does not 
yet know just what is wrong — who must know soon, if 
he is to be given his due chance for recovery. I feel 

9 



10 FOREWORD 

also that I am able to understand the viewpoint of those 
who have just been informed that they are suffering 
from tuberculosis, and who are now making ready to 
build themselves into robust, useful men and women. 
As an expression of the desire to help those who are 
anxious to insure to their dear ones and to themselves 
the continued possession of that wonderful and tre- 
mendous asset and birthright — a strong and sturdy body 
— I have prepared these lessons. 

True, a number of excellent books on tuberculosis 
intended for the general public have already been pub- 
lished. Yet, after all, what a small proportion of those 
who need the information are even aware that such 
works are in existence ! Besides, so far as I know, there 
is no book which goes into detail on each and every 
phase of the subject on which the average man or woman 
desires accurate and specific answers. This book is the 
result of an effort to supply this need. In it I have 
endeavored to tell the story of tuberculosis in concise, 
non-technical, every-day language, and to present the 
lessons in an attractive, handy and practical form, so 
that ready and easy access will be provided to this or 
that part of the subject that most interests one. 

The chief purpose of the lessons is to indicate the 
course of procedure that the competent physician will 
probably follow, and to outline in a general way the 
program he may be expected to map out for his patient. 
It will be found, also, that considerable space has been 
given to making plain the how and why, for I have felt 
that if the reasons for the various steps are understood, 
one will not only be enabled to select one's physician- 
friend and counselor to better advantage, but if the 
pursuit of health is taken up understandingly, it will 
be much easier and pleasanter to accept and follow the 
rules of living formulated by one's physician. 



FOREWORD 11 

Both those who are in doubt as to the nature of their 
illness, and those who are seeking to rid themselves of 
its bonds, are strongly urged to put their case into the 
hands of a physician who has had a large experience 
in handling like problems. In Lesson VI will be ex- 
plained why it is so important that great care be used 
in selecting one's personal physician, and will be pointed 
out how to make reasonably sure that one has chosen 
rightly. 

Only when it is altogether impossible to secure the 
advice of a physician skilled in dealing with tuberculosis 
and in whom you place trust and confidence and with 
whom you will cooperate, should you attempt to manage 
your own case. However, if this course is forced upon 
you, a careful reading of the appropriate lesson, followed 
by a little thoughtful reflection, will very likely enable 
you to accept or reject the diagnosis of tuberculosis with 
sufficient accuracy to form a basis for future action. 
Should you conclude that you have tuberculosis, then 
by carefully and conscientiously fitting the rules for 
recovery to your own needs you may look forward with 
much confidence toward ultimately winning the coveted 
prize. 

It is my earnest desire to make this book as helpful 
as possible, and criticism will be appreciated. I would 
like for the reader to feel perfectly free to express his 
opinion without restraint, and all suggestions for im- 
proving the lessons will be received with thanks. 

In preparing the lessons I have received assistance 
from a number of persons and take this opportunity to 
acknowledge my obligation to all who have contributed 
their assistance in any manner. Dr. H. A. Putnam, of 
Monrovia, California, I wish to thank particularly for 
a number of ideas pertaining to the subject of dietary, 
and I am further indebted to him and also to the late 



12 FOREWORD 

Kenneth Aitken, of Banning, for making several very 
helpful suggestions in regard to subject-matter, mode 
of expression and the like. I am especially indebted to 
Dr. C. C. Browning, of Los Angeles, Dr. Edward Preble, 
of New York, Dr. H. E. Kirschner, of Monrovia, and 
Mr. Carl Oaks, of the San Jacinto mountains, for suggest- 
ing additional topics for discussion, for proposing new or 
better ways of treating the subject-matter, or for other 
valuable suggestions. 

C. E. ATKINSON. 
Banning, California. 



LESSONS ON TUBERCULOSIS 

AND 

CONSUMPTION 



NOTE CONCERNING THE SCOPE 
OF THIS BOOK 

Tuberculosis may affect any part of the body, 
but these lessons will deal mainly with its 
most frequent and important form, tuberculosis 
of the lungs, sometimes called pulmonary 
tuberculosis. Here and there, however, brief 
mention will be made of some of the other 
rather prominent forms of the disease. 



LESSON I 

GLIMPSES OP MANY IMPORTANT MATTERS 

The main object of this first lesson is to show that it 
is necessary for everyone to have some knowledge of 
the facts concerning tuberculosis. In it will be found 
hints on many phases of the subject, the chief aim being 
to secure the interest of the reader and lead him to 
seek further light. From a different angle, all the mat- 
ters set forth herein will be more fully described in 
subsequent lessons ; yet it is believed that through giving 
a broad view of the whole subject and a foreshadowing 
of what is to follow, the reading of this first lesson will 
prove of much benefit. 

Why Everyone Should Know the Facts About 
Tuberculosis 

Not many years ago it was commonly true that he 
who discovered that he was a victim of " consumption' ' 
felt that his days were numbered. Altho the afflicted 
person believed that at all events he probably would live 
for a considerable time, and that by putting up a brave 
fight the end might be staved off for a longer period, 
yet deep in his heart lay the conviction that sooner or 
later, following a lingering illness, he would almost surely 
die as a result of the malady. Years later, under the 
growing light of scientific knowledge, many a dark and 
despairing soul was flooded with the sunshine of hope 
as the new view that tuberculosis is curable gained 
general circulation. 

15 



16 LESSONS ON TUBERCULOSIS 

To-day, notwithstanding the fact that the disease is 
known to be both preventable and curable, it remains 
a menace to every household in the land. This plague 
still continues to attack more persons than any other 
equally serious malady, and kills a larger proportion of 
its victims than any other equally curable disease. Each 
year thousands of persons, just awakening to the realiza- 
tion that they have fallen prey to the disease and accept- 
ing at its face value the message of hope that has been 
spread broadcast, console themselves by looking forward 
to the bright future which they feel certain will come 
if they will only wait till the cloud of sickness has been 
wafted away. It is the sad truth that to many of these 
the bright day never comes; for a careful examination 
of the records reveals the astounding fact that only a 
minority of the persons who are attacked by the disease 
actually attain victory. 

What Is the Solution of this Paradox of Curability 
and Fatality? To the heart that is yearning for the 
restoration of health, the bare statement that tubercu- 
losis is curable seems rather meaningless when one sees 
himself going steadily downward. Fortunately the ex- 
planation is easy, and the remedy is at hand. 

Knowledge the Key to Victory 

The facts, which I wish could be stamped indelibly 
upon the mind of everyone, are as follows : 

Early in its course tuberculosis is approximately 
ninety per cent curable. It is to be regretted that during 
this early period the afflicted person usually feels and 
appears so nearly well that often his condition is given 
little attention either by himself or his physician. 
Furthermore, even if the condition is recognized before 
severe inroads have been made on the health of its victim, 
its effects are so slight that both the physician and his 



GLIMPSES OF IMPORTANT MATTERS 17 

patient are prone to neglect it ; thus the one time when 
prompt and energetic treatment could have quickly 
ended the matter is often passed by. 

Another stumbling-block has been the character of 
the measures that are of use in the treatment of the 
disease. The chief measures are so commonplace and so 
simple that often only passing thought has been given 
to their accurate application to the case in hand. The 
consequence has been that in numerous instances they 
have been grossly misapplied. Thousands of persons 
have thrown away their lives through misdirected and 
therefore futile efforts, when success was right within 
their reach, had they but known how to grasp it. 

If uniformly good results are to be obtained, it is 
essential that the disease be recognized at the earliest 
possible moment. Owing to the fact that it is ofttimes 
difficult for even the most expert physician to detect 
the condition at this time, it is imperative that one be 
prepared to help one's physician in every manner pos- 
sible. To this end it is necessary to have some knowledge 
of the disease in order that one may keep on the watch 
for its first manifestations. If then a physician who is 
expert in diagnosing and treating tuberculosis be un- 
obtainable, by putting two and two together one may in 
many cases determine the nature of the illness with suffi- 
cient accuracy to warrant the taking of definite steps to 
combat it; these measures one can, if necessary, then 
carry out unassisted, with at least a fair chance for 
success. 

"It Is Never too Late to Begin" 

Lest the foregoing lead one to believe that there is 
no ground for hope if the disease has already passed the 
early stage, it seems necessary to add that there is a 
chance for all persons. Unless the ravages of the disease 

2 — Dec. 21. 



18 LESSONS ON TUBERCULOSIS 

be extreme indeed, you still have an opportunity to ob- 
tain the coveted goal, no matter how many times you 
have previously tried and failed. Perhaps your methods 
have been faulty ; perhaps you did not keep at it long 
enough — at all events, with the proper key, the gate- 
way to health can still be opened. There is no disease 
in which the saying, " While there's life, there's hope," 
applies with greater force. A brave fighting spirit, 
coupled with understanding and persistence in the face 
of great odds, has overcome the handicap of many a 
late start. 

However, there is no question that, other things being 
equal, an early start in the race is a great advantage. 
If one has an understanding of the disease, the proba- 
bility is large that it will be recognized before it has 
made much headway ; the chance small that the remedies 
will be misapplied. 

Hope based merely on the belief that one will escape 
the disease is often misplaced. For it must be remem- 
bered that the majority of the victims of tuberculosis 
have at one time cherished this same belief, only to find 
later that it was a delusion ; and that some of them held 
the idea so close that unwittingly they blinded their 
eyes to the facts until the day for recovery had slipped 
by. So, too, hope based on mere faith that the disease 
will wear itself out, or on half-hearted or hit-or-miss 
methods, is in most cases soon lost. On the other hand, 
hope that is anchored in the firm bedrock of knowledge 
is the key to freedom. 

Lessons Learned from Mistakes of Past 

A wide variety of old and erroneous beliefs is still prev- 
alent concerning tuberculosis. As many unnecessary 
and disastrous mistakes have resulted from a misunder- 
standing of the facts, a short review of the history of 



GLIMPSES OF IMPORTANT MATTERS 19 

the disease, and notation of the milestones marking the 
path of progress, will teach much of value. By observ- 
ing the pitfalls one may learn to avoid them. 

The Distinction Between Tuberculosis and Consump- 
tion. "As old as the hills" is a phrase which may be 
fittingly applied to tuberculosis. The disease is as old as 
history, and in its advanced stage of wasted flesh — the 
stage of " consumption' * — was fairly accurately de- 
scribed by Hippocrates as early as the fifth century, 
B. C. Hippocrates also considered the malady curable ; 
and other far-seeing observers, even at that early date, 
were convinced that the disease was contagious. A few 
hundred years later, there developed a belief in the value 
of a change of residence as an aid to recovery,— country 
air, especially near pine forests, being deemed particu- 
larly advantageous, — faintly foreshadowing by nearly 
two thousand years the general adoption of the open-air 
and climatic treatment. Galen, the physician to the 
notorious Nero, was among the first to recognize that 
the drier air of certain highlands possessed healing 
virtues. 

Old Belief in Inheritance and Fatality Led to Neglect 
and Usual Failure. Until comparatively recent years, 
however, the great majority of persons — including phy- 
sicians — believed that the disease was directly inherited, 
and as a rule fatal. For this reason, when the disease 
was recognized, the unfortunate victim was only excep- 
tionally informed of the fact (even yet, too frequently 
is the true nature of the malady concealed under some 
less serious sounding name) and, as no effective treat- 
ment was instituted, he was usually doomed to a certain 
death. Often he was treated like a victim of a pestilence, 
and under the cruel influence of this unnecessary mental 
torture he went on alone, until death came to relieve his 
sufferings. 



20 LESSONS ON TUBERCULOSIS 

Later Excessive Optimism Led to Lack of Effort and 
Similar Failures. Much later, when it became more 
generally known that the disease is curable, a wave of 
excessive optimism swept around the world, giving rise 
to a new opinion — an opinion which held that recovery- 
came more easily than the facts would justify. As a 
result, very little effort was made toward eradicating 
the disease until its inroads had become so extensive that 
the condition was truly hopeless. Very few attempts 
were made to diagnose the malady in its earlier and more 
curable stage. It was the custom of many physicians 
to make light of the disease, — in fact, such a course is 
altogether too common to-day, — sometimes saying that the 
patient would outgrow the condition; and that, at any 
rate, there was no use doing anything until marked 
symptoms developed. The physician often failed to fore- 
see the ultimate unhappy ending which was probably in 
store for his patient, if allowed to drift along without 
management; and neglected the one opportunity when 
prompt, energetic treatment for a short time would have 
ended the whole matter. 

Introduction of Outdoor Living 

The First Sanatorium. During a long period of years, 
there was much groping after the truth, and many curi- 
ous theories were evolved — later to be proven incorrect, 
and cast aside ; but it was not until many centuries had 
elapsed that any decisive advance was made. In 1840, 
outdoor living, as a method for redeeming health, was 
introduced by George Bodington, an Englishman. 

A little later, the search for a means by which the 
open-air and other treatments could be suitably com- 
bined and effectively carried out, led Bodington to found 
the first sanatorium for the treatment of tuberculosis. 
These two great steps forward were not accepted grate- 



GLIMPSES OF IMPORTANT MATTERS 21 

fully. Bodington was denounced and persecuted, and 
forced to abandon his sanatorium; and altho his idea 
took firm root, it did not bear fruit until nearly twenty 
years later. 

In 1859, at Goebersdorf, Germany, in the Silesian 
mountains, Herman Brehmer, carrying out Bodington 's 
idea, likewise established a sanatorium for tuberculosis. 
Altho Brehmer was also scoffed at and considered insane, 
his sanatorium lived. To-day, the properly conducted 
sanatorium is looked upon as a haven of rest for persons 
who are unable to obtain suitable conditions for recovery 
elsewhere. 

In America in 1884, Edward L. Trudeau established in 
the Adirondack woods near the beautiful Saranac Lake, 
the great institution for the needy, which still stands — 
a monument to the name of this great pioneer. Tru- 
deau 's work gave a pronounced impetus to the move- 
ment that has been responsible for the establishment of 
a chain of well-equipped sanatoria, both public and 
private, in all parts of the world. 

Fruitless Search for Imaginary "Land of El Do- 
rado' ' Led to Many Unnecessary Disasters — Is Climate 
of Value? The effort to find the most suitable locality 
for the carrying out of the outdoor treatment early led to 
the search for a climate which in itself would effect a 
cure. It was then the custom for the invalid, on discover- 
ing his condition, to promptly sever all ties and give up 
everything — that he might make a journey in search 
for that wondrous spot supposed to possess almost magic 
power against tuberculosis. This search usually served 
only to add to the physical and mental suffering of the 
invalid, while he was led on and on, to find in the end that 
the quest was entirely futile. Yet, in some quarters, this 
excessive faith in climate prevails to-day, despite the fact 
that time and experience have taught that there exists no 



22 LESSONS ON TUBERCULOSIS 

climate having marvelous influence against the disease. 
Recently, some persons have interpreted this fact as 
meaning that climate is of no material value in combat- 
ing tuberculosis ; and therefore have neglected to obtain 
its moderate benefits. The truth is : Climate is a valuable 
remedy, but is to be looked upon only as an aid to other, 
even more valuable, measures. 

From ' 'Roughing It' ' to Rest. In spite of subjecting 
themselves to many hardships and deprivations and 
undergoing undue exertion, in these early days of climate 
worship, some recovered. Thus 4 * roughing it ' ' — or * * get- 
ting back to nature' ' plus exercise — came to be looked 
upon as an important part of the treatment ; from then 
on, exercise was taken up haphazardly by many persons 
during all stages of the disease. Altho this belief has 
since been proven incorrect, yet the retention of the 
idea by some individuals has been responsible for posi- 
tive, forceful attempts at exercise at a time when rest was 
urgently required, and has led, unnecessarily, to many 
sad failures. 

During late years, careful, conservative physicians in 
all parts of the world have become convinced of the great 
value of rest — as opposed to exercise — when the disease 
is gaining ground ; this simple measure is now ranked by 
the most eminent authorities as one of the most valuable 
weapons in the battle against tuberculosis. 

Let it be added, however, that exercise has not by any 
means been cast aside as valueless, but (if not over- 
done and taken with discretion) retains a place as a 
highly important and useful agency for later use in 
suitable cases in strengthening and preparing the con- 
valescing patient for return to work. 



GLIMPSES OF IMPORTANT MATTERS 23 
The Discovery op the Seeds of the Disease 

The Tubercle Bacilli. Near the beginning of the 
nineteenth century, the small lumps or nodules at the 
seat of the disease, called tubercles, had been recognized 
as the most distinctive anatomical feature of the malady, 
but the discovery of the cause of these structural altera- 
tions — the tubercle bacilli — did not come until years 
later. In 1865, Villemin, who had made many attempts 
to transmit tuberculosis to animals, finally saw his efforts 
crowned with success. He succeeded in transmitting the 
disease to rabbits, thus proving definitely that it could 
be communicated by other means than heredity. 

It was not until 1882 that Robert Koch, then a little 
known health officer in a small German village, suc- 
ceeded in proving beyond doubt that the germ now 
known as the tubercle bacillus is the actual cause or 
seed of the disease. Before arriving at a definite and 
final conclusion, Koch carried out four laws that he had 
formulated as necessary of fulfilment in order to estab- 
lish indisputable proof that a particular germ is the 
cause of a particular disease. These rules stated : — 

1. The suspected germ must be obtainable, either dur- 
ing life or after death, from every case of the disease. 

2. A food or soil, suitable for the growth of the sus- 
pected germ, and relatively unsuitable for the growth of 
other germs, must be found; and the germ must then 
be grown upon this artificial medium or soil until a 
pure growth or culture is obtained — that is, a culture un- 
contaminated by the presence of germs of a different 
variety. 

3. A susceptible animal must be found, and inocu- 
lated with a portion of the pure germ culture ; eventually 
the disease must be established in the animal. 

4. After death of the animal, germs of the same 
variety must be recovered from its body. 



24 LESSONS ON TUBERCULOSIS 

These laws, under the name of Koch's postulates, have 
since been accepted as fundamental principles, and have 
been successfully applied to many diseases. 

The Casting Aside of the Belief in Inheritance. With 
Koch's discovery of the role played by the tubercle 
bacillus, there was forged one more link in the chain of 
evidence against the theory of heredity. Together, these 
discoveries started the movement that finally led to the 
general casting aside of the older view; this adding 
weight to the growing belief that the disease is trans* 
mitted by direct or indirect contact. 

Recognition of the Part Played by the " Soil' '—Im- 
portance of the "Dose" of Germs. More recently it 
has been learned that various accessory factors that sap 
the vitality, thus providing within the body a soil fa- 
vorable to the sprouting of the seed, and thereby paving 
the way for the development of the disease, are as im- 
portant causes as the tubercle bacilli themselves. It 
has also been learned that if the disease is to be estab- 
lished, the bacilli themselves must be taken into the body 
in large enough number to overcome whatever amount 
of resisting power the individual may have at that par- 
ticular time. Additional light has *shown that altho 
tuberculosis is almost never directly inherited, yet, 
through one influence or another, the new-born infant 
of tuberculous parentage is in many instances predis- 
posed to an attack, — a condition which readily allows the 
bacilli to gain firm foothold. 

Childhood the Great Danger Period. Still later in- 
vestigations have established the fact that even tho 
actual symptoms of the malady may not appear until 
adult life, nevertheless, in the majority of instances, 
the seeds are sown during childhood. Thus, outbreaks 
in adult life, altho apparently primary, have been 
shown, as a rule, to be due to the reawakening of the 








TUBERCLE BACILLI AXD WHITE CORPUSCLES 

In the central part of the photo (above) the black dashes represent 
a group of tubercle bacilli — the seed*; of tuberculosis. The indistinct 
bodies are white blood corpuscles — Nature's soldiers — slightly out of 
focus. In the small drawings a corpuscle is shown changing its shape 
as it surrounds and destroys one of the germs. 



GLIMPSES OP IMPORTANT MATTERS 25 

slumbering germs — awakenings brought about by the 
intervention of one or more intercurrent influences, 
which serve to again give the disease the upper hand. 
In this manner, it has been shown that altho child- 
hood is the great danger period, yet by the application 
of protective measures begun at birth, before the seeds 
have been sown, the disease can usually be warded off. 
Revulsion of Feeling Against Doctors and Medicine. 
Many are the remedies that have been prescribed by phy- 
sicians in the hope of finding a rapidly acting and cer- 
tain cure. The taking of these remedies, as well as the 
swallowing by the victims — who are often willing to 
grasp at any straw— of a great variety of so-called 
" patent' ' medicines, which have flooded the market,— - 
some of which have been positively harmful, and all 
leading only to disappointment, — has created a quite gen- 
eral feeling of disgust with both medicine and physicians. 
In fact, in many instances, the misguided sufferer has 
been instructed to "keep away from the doctors/ ' or 
given similar unhappy though well-meant advice, which 
has often spelled defeat. 

The Rise and Fall and Revival op Tuberculin 

In 1890, Koch announced his discovery of a new 
remedy, tuberculin, which he believed to be valuable. 
The news was flashed round the world in greatly exag- 
gerated form. Victims of the disease in all its stages 
made many sacrifices in order that they might go to 
Berlin to take the widely heralded "cure." Drawn 
on in the wave of enthusiasm, many physicians forgot 
all warnings about the dangers of the remedy and, giv- 
ing it in even larger doses than Koch at that time recom- 
mended, irrespective of the extent or activity of the 
disease, etc., administered it to their patients hap- 
hazardly — for many of whom it was manifestly unsuited. 



26 LESSONS ON TUBERCULOSIS 

The result was that it was soon found that the glowing 
claims were not substantiated. High hopes were crushed, 
and a wave of skepticism swept over the world. Tuber- 
culin was condemned, and its originator ruthlessly 
criticized. In later years, calmer judgment and ripened 
experience partly justified Koch's claims. Revived, and 
now employed in much smaller doses, his remedy was 
found to have value in certain cases, as an adjunct to 
other more important measures. Recently, again, re- 
newed enthusiasm has, in some quarters, given the 
remedy too high a place. Patients who should have 
been resting have made long trips to physicians' offices 
for treatment ; and other more essential measures have 
been neglected. Among the greatest authorities, how- 
ever, the remedy has held its true place as an aid to 
recovery in selected cases. 

Hidden Menace of Early Period of Convalescence. 
Shortly after the era of definite treatment began, it was 
observed that very slight changes in the mode of life, 
such as variation of scene or occupation, or a little rest, 
frequently produced a rapid change for the better both 
in the feelings and appearance of the victim. Quite 
often, so remarkable an outward improvement took place 
that, after a few weeks or months, considering himself 
well, the individual undertook too much; not rarely, as 
a result, a relapse, perhaps worse than the first attack, 
followed. Later, it was noted, especially in milder cases, 
that similar periods of improvement sometimes occurred 
spontaneously — absolutely without any change or 
remedy. From these observations, there ultimately de- 
veloped the realization that the early period of treat- 
ment, when the patient seems apparently well, is in 
reality a time of great danger; and that, altho tem- 
porary improvement can usually be easily and rapidly 
obtained, permanent results require persistence for a 



GLIMPSES OF IMPORTANT MATTERS 27 

much longer period. Thus came the discovery that the 
element of time is a factor of extreme moment. 

Dangers of Overeating. It was early learned that 
forced feeding was one means by which a rapid gain in 
weight could be obtained. The taking of enormous 
quantities of milk, eggs and other food then became 
common. Under this " stuffing' ' process the patient's 
appearance changed rapidly for the better, and it was 
not long until he felt that he was well. However, in 
many cases the extra burden of caring for so large a 
quantity of food proved too great a tax on his capacities, 
which sometimes gave way under the strain, resulting in 
heart or kidney disease, or in some serious derangement 
of the stomach or bowels. 

Then too, after a time, the closer observers began to 
notice that true healing in the lungs did not keep pace 
with the accumulation of fat, and that the patient was 
given a false feeling of security that caused him to do 
many things that were harmful. For one or more of 
these reasons, it often came to pass that the flabby flesh 
was rapidly lost, and the invalid soon found himself in 
as serious or a more serious condition than before, per- 
haps handicapped further by the failure of the stomach 
or some other organ — these things in turn causing dis- 
heartenment or hopelessness. 

As a result of these observations, that peculiar ten- 
dency of human nature to go to extremes then manifested 
itself in a growing feeling that the plan was of prac- 
tically no value. The judgment of time- has since shown 
that this general condemnation was not entirely justi- 
fied: If its limitations and faults be kept in mind the 
method is worthy of occasional use under extraordinary 
circumstances, but only when moderately applied and 
carefully adjusted to the varying capacities and needs 
of different individuals. 



28 LESSONS ON TUBERCULOSIS 

The Modern View 

A general survey of the progress of past years recalls 
to mind the familiar illustration of the swinging pendu- 
lum. In almost every phase of the subject, the applica- 
tion of the rule of extremes has at one time or another 
led to a reversal of opinions, resulting in some instances 
in the formation of new views as incorrect in one direc- 
tion as the former were in the opposite direction. 
Finally, there has come a period of steadying down and 
of crystallization, resulting in the clean-cut view of 
to-day. 

Practically speaking, tuberculosis is no longer con- 
sidered hereditary, but an increased susceptibility may 
be inherited. The disease is transmitted from one per- 
son to another by means of the seeds, the tubercle bacilli, 
which are usually thrown off in the sputum. In order 
that the disease be contracted, it is necessary either that 
a sufficiently large dose or doses of bacilli be taken in to 
overcome the ordinary resisting power of the body, or 
that the resistance be lowered below normal through the 
influence of other factors. 

In this disease "an ounce of prevention' ' is certainly 
worth much more than "a pound of cure." The means 
adapted to its prevention are simple. Childhood is the 
period of greatest danger, but there is also some danger 
of a primary or additional infection during adult life. 

Tuberculosis is curable, and it is a fact that temporary 
improvement often occurs as a result of little or no 
change in one's mode of life; but the attainment of com- 
plete victory usually requires prolonged effort. Recogni- 
tion of the condition at the earliest possible moment is of 
vital importance. In this connection, it has been estab- 
lished that in the early stage of the disease — the ideal 
time for its detection and treatment — the afflicted person 



GLIMPSES OF IMPORTANT MATTERS 29 

is hardly sick at all, and may outwardly seem entirely 
well. Yet many victims, apparently in a hopeless condi- 
tion, have seen failure turn to success by the mere 
application of the maxim, "consistency plus persistence 
wins." 

It is now appreciated that there is no royal road to 
health. Extravagant sacrifices are neither necessary nor 
wise, but some sacrifice is usually required. If one is 
willing to take the necessary steps, one can usually look 
forward to ultimate victory. 

Concealment of the true state of affairs is no longer 
tolerated; for a realization of the nature of his illness 
is required if the individual is to make a definite and 
properly directed effort to recover his health. The 
afflicted person is no longer looked upon as an outcast; 
for it is recognized that while the careless victim is a 
distinct menace to the health of others, he who is 
careful not only does not endanger those around him, 
but has a right to the pleasures of society. 

The Essence of Treatment 

The modern treatment is a happy combination of the 
various elements, including rest and exercise, fresh air, 
food, a favorable environment, climate, and medical and 
sometimes surgical, treatment — each suited to the 
peculiar needs of the individual case. 

The achievement of better results in recent ye'ars for 
the greater part has not been brought about by any 
radical change in the methods of treatment. It should 
be distinctly understood that more recoveries are ob- 
tained to-day, chiefly because (1) the disease is more 
often recognized at an earlier stage, (2) old methods are 
more skilfully applied and more accurately fitted to the 
requirements of the given case. 

Suiting the treatment in each of its aspects to the 



30 LESSONS ON TUBERCULOSIS 

varying needs of each person is a vital factor, for it is 
indisputable that the application of a "rule of thumb' ' 
has caused many failures. This adaptation can best be 
carried out under the guidance of a competent physician. 
For many, at least during the initial stages of treatment, 
a residence in one of the attractively located, well-con- 
ducted sanatoria may mean the difference between defeat 
and victory. Here, away from the anxieties and tempta- 
tions of business and home, and from the conflicting 
advices of friends, one is usually pleasantly surprised to 
find himself enjoying his stay. The fact that "every- 
body's doing it" results in a feeling of optimism that 
carries him along toward the goal, which is reached 
almost before he knows it. 

The Extent op the Disease 

Tuberculosis is the most nearly universal scourge. No 
country, no climate, is exempt from its onsweep. In cer- 
tain places its victims are fewer in number, but no 
locality in which civilized man has been is entirely free 
from its ravages. The "great white plague" respects 
neither race, class, color nor creed ; its victims are found 
among the high and among the low, among the rich and 
among the poor. Adolescents and young adults are its 
ready prey ; certain races, like the Indian and negro, it 
attacks with especial violence ; certain other races it has 
a tendency to slight ; it has its favorites, but no one is 
absolutely safe. 

Startling Facts and Figures. Within the confines of 
the United States there are at present, in round num- 
bers, 340,000 — one-third of a million — known cases of 
tuberculosis. Most of these persons are suffering from 
advanced tuberculosis; for as a rule the patient does 
not consult a physician during the early period of his 
illness ; and if he does so, the true nature of the condi- 



GLIMPSES OF IMPORTANT MATTERS 31 

tion may be overlooked. The number going about with 
unrecognized tuberculosis is enormous. A conservative 
estimate places the actual number of persons incapaci- 
tated by tuberculosis (both recognized and unrecognized 
cases) at the present time, at 1,400,000. This estimation 
refers only to patients in whom the condition has ad- 
vanced sufficiently to produce noticeable influence upon 
the health — the so-called evident or manifest tuber- 
culosis (that is to say, the condition is spoken of as mani- 
fest tuberculosis when it has become evident to the 
afflicted person that something is amiss, altho, as just 
indicated, he is often unaware of the exact nature 
of the trouble) ; and does not include the much larger 
number who at some time during life harbor a mere 
trace of tuberculosis but who show no outward evi- 
dence of the condition. Many carefully kept series of 
statistics, based upon the records of thousands of 
autopsies and upon other reliable tests, bear witness to 
the enormous prevalence of the disease. 

Averages One Victim in Each Family. Roughly, 
ninety per cent — nine out of ten — of all persons contract 
a certain amount of tuberculosis in some part of their 
bodies at some time during life. However, the majority 
of this number have only a trace; yet according to a 
moderate estimate, one out of six, or 16 per cent of all 
individuals, give outward evidence of definite disease 
(in the ordinary sense of the word — that is, they suffer 
from manifest tuberculosis) during some part of the life 
span. In other words, on the average there is one vic- 
tim of the disease in every family. 

During its so-called incipient, or first evident stage, 
tuberculosis is about 90 per cent curable ; in other words, 
nine out of ten should get well. It may be well to add 
that this 90 per cent factor of curability concerning firsf- 
stage tuberculosis has been repeated s^- often and ac- 



32 LESSONS ON TUBERCULOSIS 

centuated so pointedly, that many have come to accept 
the figure as 100 per cent; and the viewpoint of some 
has even become so optimistic that they consider that the 
whole one hundred obtain a cure with little or no effort. 
There is no more ground for this belief than there was 
for the prevailing idea of thirty years ago that the 
disease was almost invariably fatal. The view that 
tuberculosis is incurable and the opposite belief that 
incipient clinical tuberculosis is a matter of small con- 
sequence, which will mainly attend to itself, are both 
wrong. One is exactly as fallacious and as dangerous 
as the other. Both have led to neglect and been the 
direct cause of untold harm and many unnecessary 
deaths. 

Is Tuberculosis Always Serious? 

It should be emphasized strongly that by the time tu- 
berculosis has attained sufficient foothold to produce 
symptoms (evident or manifest tuberculosis*), the dis- 
ease is always serious. 

Altho it as probable that 90 per cent or nine out 
of ten, of early cases are curable, less than 50 per cent 
or one out of two, actually attain cure. (These figures 
include those who make every useful effort, those who 
make half-way effort, and those who make none. If only 
those who make no attempt to conquer the malady be 
considered, the number who recover is very much 
smaller.) 

Unfortunately, there is no way to accurately foretell 
which persons will recover without much effort, and 
which ones will have to put up a vigorous, sustained 
fight. Those who are inclined to make light of the disease 
will do themselves a turn of vast benefit by recalling that 



* Hereafter, in this book, unless otherwise stated, all refer- 
ences to tuberculosis are to be understood as pertaining to 
manifest tuberculosis. 



GLIMPSES OF IMPORTANT MATTERS 33 

in the life of nearly all patients there was a time when 
the symptoms were mild and the process just beginning ; 
therefore, if a good result could be easily obtained in so 
many cases, why did the disease continue to progress to 
the second or third stage ? 

Death Rate of Tuberculosis Reduced, but Still a 
Great Peril. Formerly, one out of seven of all individuals 
died of tuberculosis. Due to the general adoption of out- 
door living and of other hygienic measures, including 
the care of the sputum, the death rate from the disease 
has been considerably reduced, — in fact within the last 
thirty years it has been cut down almost 50 per cent — 
but even to-day one out of eleven deaths are directly 
traceable to tuberculosis. 

Despite this great reduction in mortality, tuberculosis 
still stands as one of the most able lieutenants of the 
Grim Reaper, and annually in the United States alone, 
more than one hundred and forty thousand lives are 
sacrificed as a direct result of this disease. Between 
the ages of fifteen and sixty approximately 30 per cent, 
or almost one death out of three, is ascribable to the 
great white plague. Between the ages of twenty and 
thirty-five, roughly, one death out of two is due to the 
disease. 

Notwithstanding the startling character of these 
figures, mere statistics fail entirely to tell the tale of the 
thousands who have been permanently crippled and 
whose deaths have undoubtedly been brought on pre- 
maturely by tuberculosis, although the immediate cause 
of death has been some other malady. 

Some Vital Comparisons. According to the rule of 
averages, the individual afflicted with a mild attack of 
tuberculosis — that is to say, who has incipient manifest 
tuberculosis — is, if the disease be neglected, subjected to 
a greater danger than the victim of a severe attack of 

3 



34 LESSONS ON TUBERCULOSIS 

pneumonia. Altho the course of tuberculosis may be 
drawn out from three to five, or even ten to twenty, years 
or more, yet the victim of tuberculosis is eventually the 
more likely of the two to succumb to his malady. The 
chance for loss of life from untreated incipient tuber- 
culosis is in the long run many times greater than the 
chance taken through an attack of appendicitis; and 
even without operation the hope of the victim of ap- 
pendicitis for living to a good old age is several times 
more likely to be fulfilled, than is the hope of the suf- 
ferer from incipient tuberculosis if he allows his con- 
dition to drift along without proper attention.* 

One point is sufficiently important to bear repetition. 
Practically one individual out of every six shows 
symptoms of tuberculosis at some time during his life, 
making an average of one member in every family. As 
matters have gone in the past, this one unlucky individ- 
ual per family has had less than one chance out of two 
for recovery. On the other hand, he should have a 90 
per cent chance if the disease is at once recognized 
and the proper measures taken. This 90 per cent of 
the afflicted will, however, realize recovery under present 
methods only when these methods are more generally 
put into effect than they have been in the past. 

As seen from another angle : Of the one hundred mil- 
lion people alive in the United States to-day, under 
prevailing conditions approximately 90 per cent or 
ninety million now have, or will develop, a trace of 
tuberculosis infection. In 6 per cent, or sixteen mil- 
lion, the infection will progress to the development of 
genuine tuberculous disease (evident or manifest tuber- 
culosis). Furthermore, unless a greater number than 



* The death rate from pneumonia is approximately 35 per 
cent. The death rate from appendicitis, unoperated upon, is 
approximately 20 per cent. The death rate from manifest tuber- 
culosis, if left to itself, is approximately 70 per cent. 



GLIMPSES OF IMPORTANT MATTERS 35 

have formerly done so discover their condition in time 
and at once begin effective treatment, more than one- 
half of this sixteen million — or nine million, that is 9 
per cent of the total population, or one out of eleven 
of all persons — are doomed to die as a direct result of 
tuberculosis. 

If Tuberculosis Is Preventable and Curable, Why So 
Many Failures? Of the many individuals who are 
suffering from unrecognized tuberculosis at the present 
time, many are deceived or are deceiving themselves into 
believing that they are afflicted with some other condi- 
tion or ailment. A large number of these persons do 
not appear seriously sick ; some do not seem sick at all. 
Because the symptoms in the early stage are as a rule 
so few, the majority of victims drift on into advanced 
disease before the real condition is recognized. Awaken- 
ing almost too late to the danger that confronts them, 
they are forced to fight for years to obtain the goal, 
which at an earlier period might have been won in a 
few months. How often the cry of the disheartened suf- 
ferer has been raised "Oh, if I had only known!" 

Perhaps you are one of these unfortunates ; or perhaps 
you are fortunate in discovering your true condition 
early. Possibly you are unconsciously endangering your 
wife, your daughter, or other dear ones. May not some 
member of your own family be already within the 
shadow? By acquiring some knowledge of the disease 
you may protect both yourself and those around you, 
saving years of suffering or perhaps the loss of life. 

An Answer in Advance 

Critics may say that too much of the dark side has 
been shown here, claiming that this will cause unneces- 
sary mental suffering, perhaps discouragement. The 
reply is that it is essential that the truth be stated — 



36 LESSONS ON TUBERCULOSIS 

neither minimized nor exaggerated — so that, after look- 
ing the matter squarely in the face, the sufferer will 
recognize the seriousness of his illness before it is too 
late. Certainly it is true that unless the true nature 
of the condition be brought home to them, few will take 
the steps that lead back to health. Only through a plain 
presentation of the facts will the mass of the people be 
awakened to this peril. 

Detailed reference to the outcome of advanced cases 
has been omitted here, because it has been felt that by 
confining the attention to early cases only, the point 
would be emphasized that even so-called incipient 
tuberculosis is not the negligible matter it has some- 
times been considered. There is hope for those with 
even the most advanced disease, but the application of 
proper measures at the earliest possible moment means 
not only money in the pocket but is the strongest in- 
surance of success one can take out 

In these pages you have gained some insight into sev- 
eral phases of the subject. In the lessons that follow, 
each of the topics herein mentioned, with many others, 
will be considered in detail. As you go forward you will 
find that each lesson is quickly mastered and that it is 
easy to apply the various suggestions, instructions and 
rules set down therein, to your own needs. Whether you 
wish to know how to prevent the disease, how it may be 
recognized in time, or how to win back health, you will 
find the knowledge gained to be of immeasurable value 
to you throughout life. 



LESSON II 

SOW TUBERCULOSIS IS SPREAD 

The Seeds and the Soil 

Just as each species of plant takes its origin from 
seeds of a special variety, so tuberculosis takes its origin 
from its own peculiar variety of seeds, which in this 
case are minute germs, called tubercle bacilli. Just as 
the seeds of the plant will not take root and mature 
unless the soil is fertile, neither will the seeds of tuber- 
culosis, the tubercle bacilli, grow and multiply and cause 
illness, unless the particular tissues of the body in which 
the germs happen to lodge are at the time of their im- 
plantation in at least a fairly favorable or receptive 
condition. Thus, if the disease is to develop the bodily 
soil must be at least fairly fertile, and the seeds moder- 
ately abundant and reasonably vigorous. 

Oddly enough, tho the germs of tuberculosis hold a 
titanic sway over the well-being of the human race, they 
appear under the miscrosaope simply as minute, colorless, 
and seemingly inanimate rods, which are often slightly 
bent and have a tendency to group themselves in small 
clumps. Roughly, they resemble the dashes used in 
printing. Altho they are really living, single-celled 
organisms, their life is not made manifest by move- 
ment. In other words, tho they are living in the same 
sense that plants are living, their exact place in the 
vegetable or animal kingdom has not been definitely 
established. The familiar, comic conception of the car- 

37 



38 LESSONS ON TUBERCULOSIS 

toonist, representing germs as many-legged, wild-eyed, 
long-beaked monstrosities, differs from the true picture 
of the tubercle bacilli almost as much as black does from 
white; for even when stained for more careful study, 
they appear merely as bright red rods of a more or less 
irregular or beaded contour. 

The germs of tuberculosis are cast off in the sputum 
of the victim of the disease in enormous numbers, and 
are scattered almost everywhere. It has been estimated 
that a single afflicted person may eliminate in his 
expectoration more than twenty-five billion daily. 

How the Germs Enter the Body 

In nearly all cases, the germs are taken into the body 
either in the air that is breathed, or in food or drink. 
What happens after the germs once reach the throat 
depends upon several factors, to be discussed more fully 
a little later. Suffice it to say here that from the throat 
onward, the invasion may proceed by one of three 
routes: — 

1. The germs may be swept on in the air current, into 
deeper portions of the breathing apparatus. 

2. They may be carried onward in food or drink into 
the stomach and bowels. In this event, for the greater 
part they pass on in the excreta, without harm resulting. 
Not rarely, however, they penetrate the walls of the 
intestinal canal and, sooner or later entering the vital 
stream, are carried along with the current until (usually 
in the lungs) a soil suitable for their growth is reached. 

3. They may enter the tonsils or other similar struc- 
tures in the throat (including those small tissue masses 
that, when enlarged by disease, are spoken of as "ade- 
noids") and thereafter by another roundabout route 
ultimately reach the lungs. 

It seems well to emphasize the fact that all three 



HOW TUBERCULOSIS IS SPREAD 39 

of these avenues are sources of danger through 
every period of life. Nevertheless, the breathing 
tract seems to be a more common portal of entry during 
adult life than it is during earlier years; whereas the 
digestive canal and tonsils appear to play a greater part 
in childhood infection * than they do after maturity is 
reached. 

Why Everyone Does Not Acquire the Disease 

With so many persons in all civilized countries, know- 
ingly or unwittingly, continually spreading broadcast the 
seeds of tuberculosis, it may seem a great wonder that 
any one escapes. To this question there are several 
answers : — 

In the first place, there is a wide variation in the vigor 
and power to work harm, among tubercle bacilli. It is 
to be understood that all of these germs are not exactly 
alike. While, of course, all of them belong to one great 
family, yet they differ among themselves in minor ways, 
just as one race of human beings differs from another in 
certain peculiarities. Of these races or tribes of the 
tubercle germs, the four following races are quite dis- 
tinct and especially important : — 

1. The so-called human type, which causes tuber- 
culosis in the human being. 

2. The bovine strain, which produces tuberculosis in 
cattle, commonly called "pearl disease,' 9 because of the 
translucent, pearl-like character of the tubercles — and 
which sometimes causes disease in man. 

3. The avian type, which leads to tuberculosis in 
chickens and other fowls, and occasionally in animals. 

4. The reptilian group, which produces tuberculosis 
in the cold-blooded creatures. 



* By infection is meant that the germs have gained the upper 
hand over the defensive forces, at least for the time being, and 
have succeeded in gaining a temporary or permanent lodging in 
some part of the body. 



40 LESSONS ON TUBERCULOSIS 

It will be noted that only the first two varieties menace 
the human being to any noteworthy degree. It is also 
worthy of mention that some of the germs even within 
the individual classes or tribes are highly virulent 
(dangerous), whereas others are only slightly so. 

In the second place, we are also protected from the 
great horde of the tubercle germs sown almost every- 
where, by the beneficent influence of the sun. Owing to 
the disinfectant action of sunlight, these myriads of 
germs are for the greater part destroyed, or at least 
weakened and rendered much less dangerous. Luckily 
it is also true that under ordinary conditions tubercle 
bacilli rarely if ever multiply outside of the body. 

Yet in spite of these facts, from the cradle up nearly 
every person does take into his body a greater or less 
number of the germs of tuberculosis. Notwithstanding 
that many of these germs are decidedly virulent, no 
damage is done as a rule, because the well person has 
a certain amount of inherent resisting power which 
enables him to overcome the germs at once, before they 
succeed in gaining a foothold. 

The Body a Fortified Citadel 

Foreseeing that the human race would have many 
microscopic enemies, Nature wisely and generously 
endowed the body with several agencies of defense, 
through one or the other of which she hoped to resist 
successfully all attacks. In this protective scheme, that 
familiar and of ttimes troublesome organ, the nose, plays 
a simple but effective part ; for as the germs are swept 
along in the current of the inhaled air, many are caught 
and held back by the small hairs just within the nostrils. 
Others are weakened or killed by the more or less ger- 
micidal secretions of the nose, or are cast away in the out- 
flowing discharge. Should any escape this filter-like 



Location of 
Adnoids 



Right Tonsil 



Lymph glands of 4 
neck and chest 




DIAGRAM OF BREATHING APPARATUS AND LYMPHATIC 
SYSTEM 

The lymph glands, including the tonsils, are the fortresses of the 
body; but if this system of defense fails, an actual pathway is provided 
for the entrance of the germs. Other avenues through which the germs 
may enter are via the breathing passages and by way of the stomach. 



HOW TUBERCULOSIS IS SPREAD 41 

mechanism of the nose and enter more deeply into the 
breathing passages, they, too, are usually wafted back 
without harm ensuing, by the wave-like movement of 
minute hair-like processes or lashes — called cilia — 
springing from the lining of the bronchial tubes. 

In addition to these locally operative defensive devices, 
the body has also been supplied with a more general 
means of protection. As a matter of fact, Nature has 
constructed within the body a perfectly wonderful and 
intricate series of fortresses, the lymph glands. These 
fortresses, built in large numbers at all the most vulner- 
able points, are linked together in chain after chain 
by a maze of interlacing, communicating pathways, the 
lymph vessels, in which there is constantly flowing a 
protective liquid, called lymph. So, no matter by what- 
ever portal the germs gain access to the body, one of these 
lymph gland outposts will almost at once bar the way to 
their further passage. For example, in the throat itself 
Nature has built a number of these protective barriers, 
including (1) the tonsils — which are really specialized 
lymph glands — and (2) those small, slightly protruding 
tissue masses in the vault or arch of the throat — pre- 
viously mentioned — which, when enlarged as a result of 
disease, are termed " adenoids.' ' 

It is obvious that if these normally protective struc- 
tures of the throat, guarding the passageways to (a) the 
stomach and bowels and (b) the windpipe, should be- 
come weakened by disease, they will not only lose their 
effectiveness as barriers but, like fortresses that have 
fallen into the hands of the enemy, will actually open up 
new gateways, through which the germs may pass ; after 
which they may sweep on through Nature's system of 
communicating pathways (the lymph vessels), which 
have thus been converted into avenues of invasion, and 
enter right into the very interior of the body. How 



42 LESSONS ON TUBERCULOSIS 

important it is, then, for the throat to be constantly 
maintained in a healthy condition, so that its fortifica- 
tions will always be in proper working order. 

Then, too, the circulating liquids of the body, the blood 
and lymph, have germicidal and antidotal properties 
useful in destroying and weakening the germs and in 
neutralizing their poisons. More : The body has a huge 
army of millions and trillions of mobile soldiers (the 
corpuscles of the blood — both white and red — and other 
cells), ready at instant call to engage in combat with 
the enemy. So when Nature recognizes danger at any 
of her frontiers, numerous divisions of her immense 
standing army are rushed to the point of attack, while 
coincidentally she swells the ranks of her army with 
millions of new recruits and starts her munition fac- 
tories running full blast to add to the germicidal and 
antidotal power of the blood and lymph. 

In the great majority of instances the defensive forces 
succeed in destroying the first invaders. This is true, 
provided their number is relatively small and that they 
are not extraordinarily powerful. As a result of destroy- 
ing the first germs, the ability of the body to resist a 
future invasion of the same variety of germs is 
augmented, at least for a time. (This statement is sub- 
stantiated by a wide range of investigations carried out 
on animals.) So if the individual is unfortunate enough 
to receive later a larger dose of the same kind of germs, 
because Nature's protective forces now — so to speak — 
have been keyed up to a fighting pitch and become fa- 
miliar with the fighting methods of the enemy — her 
forces will still be able to keep the invaders from gain- 
ing the upper hand and obtaining a lodging. Hence, 
even if larger and larger doses of germs should be taken 
in, provided the additional number of germs is not so 
great as to overbalance even the strengthened and in- 



HOW TUBERCULOSIS IS SPREAD 43 

vigorated defense of the body, the individual gradually 
acquires a considerable fund of resistance — a so- 
called relative immunity — which is of material service 
in fortifying him against a future attack, and in favor- 
ably modifying the course of tuberculosis if it should 
develop. 

If, however, at any time there be taken in a dose or 
doses of the germs so large that the body fails to van- 
quish them, or if for any reason the defensive forces 
should temporarily become depleted, the germs may 
assume control of the situation. This danger is of course 
accentuated if the bodily resistance fund be reduced, and 
the dose be increased, coincidentally. 

Predisposing Influences 

Here it may be well to point out the factors that de- 
plete the body 's defenses and hence predispose to tuber- 
culosis. The principal predisposing influences exert their 
effect on the body as a whole, and are in a large part 
brought about through unwholesome working or living 
conditions. They include : (1) overwork, or undue physi- 
cal or mental exertion of any kind, such as prolonged 
worry or great grief, (2) insufficiency of fresh air, (3) 
inadequate nourishment — which may or may not mean 
under eating, and (4) the abuse of alcohol. In other 
cases, certain diseases, particularly measles, whooping 
cough, la grippe, pneumonia, and even the supposedly 
mild and innocent everyday cold, seriously sap the de- 
fensive forces of the body and thus pave the way for 
the development of tuberculosis. With these factors in 
view, the influence of living in a crowded city, where 
one is almost constantly indoors, and where at any rate 
one is always surrounded by dusty and germ-laden air, is 
easily understood. Residence in an unfavorable climate, 
and exposure to intense cold and extreme dampness, altho 



44 LESSONS ON TUBERCULOSIS 

unquestionably of less moment than were formerly sup- 
posed, none the less have some bearing upon the acquire- 
ment of tuberculosis, and exceptionally, as in war-time, 
play a more prominent part.* 

The Effect of Heredity 

The fact has now been definitely established that direct 
hereditary transmission of tuberculosis is so rare that 
for practical purposes it may be disregarded. Notwith- 
standing this statement, it is well for it to be understood 
that the child whose father or mother suffers from tuber- 
culosis may be born with a definite tendency or predis- 
position to the disease. This predisposition, or liability, 
is often a general one; in other words, the infant may be 
poorly nourished and weak at birth, and hence liable to 
be attacked by any and every ailment that comes along ; 
including, of course, tuberculosis. On the other hand, it 
is possible and fairly probable that the child will in- 
herit a specific inclination or susceptibility to tuber- 
culosis. 

This specific susceptibility may in turn be a general 
predisposition — a predisposition of the body as a whole 
to tuberculosis — or it may be brought about by the 
adaptation of the soil to the tubercle germs only in some 
particular part of the body — for instance, say, in the 



* Occasionally the resisting power may be lowered only in 
some particular part of the body; the organ or part so affected, 
then becoming — as it were — a fertile soil for the lodgment and 
growth of the seeds. Thus, by way of illustration, a severe blow 
on the chest, or violent cranking of an automobile may so injure 
the delicate fabric of the lung as to fit it only too well for the 
lodgment of the germs of tuberculosis. Local injuries such as 
this are, however, comparatively unimportant as predisposing 
causes (of a primary outbreak) of tuberculosis. On the other 
hand, once the disease has become active or manifest, violence of 
this nature — being in direct opposition to the principle of rest- 
is then to be abjured at all cost. 

A better example of harm resulting from local injury is found 
in athletes who, in striving to overdevelop their "wind," have 
so overtaxed the capacity of the respiratory organs (and heart) 
that the strain has created a point of lowered resistance — a local 
weak spot or fertile soil; so that later instead of finding the 
longed-for super-strength, their only reward has been the reap- 
ing of tuberculosis. 



HOW TUBERCULOSIS IS SPREAD 45 

lungs. Yet a more careful scrutiny of cases has shown 
that the inheritance of a limited area of lowered resis- 
tance — a local ' i weak spot ' ■ — is less important than many 
assume. Heretofore it was quite generally believed that 
the person who was round shouldered and who had a 
long, narrow, and perhaps flat chest, was exceedingly 
liable to break down with tuberculosis ; conversely, those 
who were full-chested and of a fairly athletic build were 
held to be almost immune to the disease. Now, however, 
the foremost investigators are coming to look upon the 
thin, flat chest as being more a result of disease rather 
than a cause. The truth is that the individual who 
has a chest of this type is often already afflicted with 
tuberculosis, or has suffered from the malady in the 
past. Less frequently, of course, some other illness 
may be responsible for the alterations; whereas in still 
other cases, heredity does have some bearing on the 
matter. 

How Tuberculosis in Ancestry Has a Salutary Effect. 
Directly opposed to the passing on of a tendency to 
tuberculosis to the descendants it is a curious fact that 
the offspring of tuberculous persons may receive from the 
parents something which is an actual and positive aid 
to the child in warding off an attack. In this connec- 
tion, the recital of some singular and illuminating facts, 
concerning the lives of several one-time, war-like tribes 
of natives inhabiting the Marquesas Islands in the South 
Pacific, may not be out of place.* 

The Wrecking of a Once Powerful, Eace 

A few centuries back, the savage dwellers on these 
islands, numbering some twenty thousand, were a race 
of extraordinarily hardy and robust individuals, wholly 

* A popular, highly interesting* and graphic account of the 
strange events that occurred on these islands may be found in 
Chapter X of Jack London's book, "The Cruise of the Snark." 



46 LESSONS ON TUBERCULOSIS 

free from blemish, physically perfect — a virile people 
to whom hardships were nothing and whose endurance 
was practically unlimited; who were in fact, from a 
physical standpoint, super-men and super-women. Can- 
nibals tho they were, the Marquesans of that date were 
set down by more than one explorer and traveler as 
veritable sculptors' models. At that time sickness was 
almost unknown among the islanders. 

Some few hundred years later the picture was entirely 
different. With the coming of the white man, bringing 
disease with him, the race fell heir to many ills, includ- 
ing tuberculosis, which swept like wild-fire through the 
communities, leaving in its wake a very different and 
saddened people. The race of athletes had become a 
race of feeble, tottering and gasping invalids, and even 
of these only a comparative handful remained. 

One may well ask: What is the significance of this 
peculiar turn of events? In answer, it may be stated 
that the violence of the outbreaks of disease imported by 
the white man among these poor people was in large 
part ascribable to their nearly complete lack of familiar- 
ity with, and consequent lack of resistance to, illnesses 
of all kinds. Because for generations back the tribes 
had not known what the word sickness meant Nature 
had not been stimulated to fight disease, so when at last 
it came to them they were caught almost entirely un- 
prepared. 

As compared with the Marquesans, the ancestors of 
modern civilized man have suffered and fought with 
tuberculosis since the beginning of history. In conse- 
quence of the handing down of protective influences 
from generation to generation, notwithstanding the 
pernicious living conditions of the present age, we of a 
later day, despite our relatively disfigured and mal- 
formed bodies, escape the furious attacks of disease to 



HOW TUBERCULOSIS IS SPREAD 4Z 

which the aborigines fall easy victims. Thus is explained 
the ordinary slow, chronic, comparatively mild course of 
the average case of tuberculosis nowadays. Hence, the 
very fact that at the present time the disease is usually 
of this type, lends support to the view that we inherit 
a certain amount of actual protection against tubercu- 
losis. For if it were otherwise, the sick person would, as 
a rule, die in a short time, as a result of a severe acute 
attack. 

The Effect of Inheritance in a Nutshell. In a word : 
(1) The child may inherit influences that make him 
prone to the disease. These may be (a) on the one hand, 
general, that is, favoring the development of all kinds 
of ailments, and (b) on the other hand, specifically 
predisposing him to tuberculosis, alone. (2) He may 
inherit influences that protect him against tuberculosis. 
(3) He may inherit both kinds of influences — both those 
that make him more liable to tuberculosis, and those 
that aid him in overthrowing or warding it off. On the 
whole, according to the overbalancing factor, the child 
may be said to be (1) predisposed, or (2) protected. In 
the average case, the sum total of the influence of 
heredity amounts to this : Other things being equal, the 
descendant whose parents have suffered from tuberculosis 
will be more inclined to contract the disease than will 
the child whose blood is free from taint — so to speak; 
yet, odd as it may seem, according to the law of aver- 
ages, he whose ancestors have been afflicted with tuber- 
culosis is, if there be any difference at all, likely to find 
the difference in his favor. That is to say, the disease in 
this case has a tendency (to which there are, of course, 
exceptions) to be of a milder, more curable, chronic type. 
| Condensed into a single sentence, heredity is seen to be 
not at all the tremendously serious factor that many be- 
lieve it to be. In very truth, were it not for the fact 






48 LESSONS ON TUBEKCULOSIS 

that our ancestors — either immediate or for years back — 
have been attacked by the disease, we who have come 
later would (provided tuberculosis should suddenly 
spring into existence) be swept from the earth by the far- 
reaching onsweep of the scourge in its most virulent 
form. 

The Important Lesson Learned from Heredity. The 
one fact pertaining to heredity to which we should 
cling fast is this: Even tho for generations back in 
successive families, one child after another, seemingly 
predestined to follow in the footsteps of those who 
have preceded him, on reaching a certain age has 
been smitten by tuberculosis, and has crumpled up and 
fallen as from a violent blow — even in such cases, the 
malady can usually be successfully and permanently 
warded off, if suitable measures are instituted immedi- 
ately after birth, ere the germs enter the delicate 
young body And overwhelm its feeble defensive forces. 

Common Misconceptions 

Just as certain persons are inclined to make light of 
the risk of acquiring tuberculosis from one who is already 
a victim of the disease, others are equally inclined to 
exaggerate the danger. For this reason, it seems well to 
lay emphasis on the fact that infection is as a rule a 
slow process. That is to say, multiple doses of bacilli 
(with quite a number of bacilli present in each dose), 
spread over a considerable period, are usually necessary 
to overcome the protective forces of the body. This ex- 
plains how it is possible for some of us to escape, despite 
the daily, but passing, exposures of the street (chiefly 
due to promiscuous expectorating), in restaurants, hotels 
and the like, or as brought about through intimate, 
tho temporary, association with an afflicted person. 
As a matter of fact, one runs only slight chance through 



HOW TUBERCULOSIS IS SPREAD 49 

casual contact of this nature, no matter if the afflicted 
person has the disease in an advanced stage. Moreover, 
even an occasional short visit with a very careless con- 
sumptive seldom leads to harm. The point should be 
emphasized that there is no danger at all of acquiring 
tuberculosis unless the afflicted person suffers from the 
"open" or communicable type of the disease. (In Les- 
son IV, p. 85 may be found a description of both "open" 
and "closed" tuberculosis.) 

In the great majority of instances those who contract 
tuberculosis do so because they have lived for a long 
period of time in close association with a careless victim 
of "open" tuberculosis. As will be shown in a moment, 
such association is most harmful if occurring during 
childhood. It should not be forgotten, however, that it 
is possible for the germs of tuberculosis, scattered by 
inconsiderate persons, to remain alive for weeks or 
months in dark, dusty, poorly ventilated rooms, and to 
infect the next occupant. 

Contrary to the rather common belief, there is no 
danger from the air expired by a consumptive during 
quiet breathing. On the other hand, during spells of 
violent coughing, and as a result of boisterous laughing 
and the like, the spraying of germs into the air is a 
distinct menace to those in the immediate neighborhood. 
The risk is especially great within the distance of four 
feet. 

Childhood the Great Danger Period 

At What Age Is Infection Most Liable to Occur? In 

answer it may be stated that the tender body of the 
growing child is the most favorable soil for the implanta- 
tion and growth of the seeds of tuberculosis. For this 
reason infection most commonly takes place during early 
life. The new-born infant as a rule has but moderate 



SO LESSONS ON TUBERCULOSIS 

resistance against disease in general. Yet if from time 
to time it takes in only a few tubercle bacilli, even its 
scanty store of defensive force may prove adequate to 
protect it. In this case the germs are destroyed ; infec- 
tion does not develop, and the youngster's resistance is 
gradually raised. This means that if he is subjected 
to a larger dose of germs in the future, his powers of de- 
fense will perhaps be strong enough to overcome them. 

On the other hand, if at any time so many of the tu- 
bercle germs are taken in that the defensive forces are 
unable to overcome them, the germs establish a colony 
within the body — and the child is said to be infected. 

The child as a rule has more opportunities for infec- 
tion than the grown person. During babyhood it is 
closely fondled by many persons, some of whom may 
have tuberculosis in recognized or unrecognized form; 
and for a number of years it spends a considerable por- 
tion of its time on the floor or ground, where germs set- 
tle. Moreover, it is continually picking up and putting 
into its mouth all sorts of objects, contaminated more or 
less with dirt and germs — from expectoration or other- 
wise. Likewise, cows' milk, which forms a large part 
of the little one's food supply, is frequently contaminated 
with bovine tuberculosis bacilli — thus adding another 
danger. All in all, if the boy or girl is housed with a 
person ill of tuberculosis (of the open or communicable 
type) — be it one of the child's own parents or another 
person — the child is almost sure to be infected unless 
the utmost precautions are taken. 

What Happens After the Child Is Infected? It is 
not to be understood that all of the children in whose 
bodies merely a few tubercle germs have gained lodg- 
ment are outwardly ill. To be sure, in some cases, a 
heavy, even ineradicable imprint is left on the delicate 
bodies. In others, however, soon after the germs enter 



HOW TUBERCULOSIS IS SPREAD 51 

the bodily portals, the lymph gland fortresses effectually 
bar the way to its fertile fields (including, especially, the 
lungs). The defensive forces may then completely de- 
stroy the invaders. 

How the Germs Slumber in the Body for Long 
Periods. On the other hand, the affair has often a 
somewhat different and less decisive termination. In 
this case, altho the progress of the germs has been 
checked, the forces of Nature prove inadequate to com- 
pletely rout the enemy. Thereupon, a truce — as it 
were — is declared, during which period the germs lie 
slumbering or dormant for a longer or shorter time 
(latent tuberculosis). As a matter of fact, the infection 
frequently remains latent or dormant permanently, and 
the youngster may tread life's pathway to a good old 
age without experiencing one sick day from this cause. 
In this instance, not only is the individual himself en- 
tirely unaware that his body harbors a colony of the 
germs of tuberculosis, but the condition may be wholly 
indetectable, except to the most expert and careful 
examiner. 

This state of affairs is sometimes spoken of as a mere 
tuberculous infection, to distinguish it from the more 
serious condition in which manifest symptoms of ill 
health are produced, warranting the use of the term 
tuberculous disease (also called evident or clinical or 
developed tuberculosis). 

Why Tuberculosis of the Lymph Glands Is Common 
in Childhood. In yet other cases, the matter has a, 
less fortunate ending. It sometimes comes about that 
after the lapse of an interval of indefinite length, the 
germs regain power, multiply rapidly and sooner or later 
acquire mastery of the situation. Thus there is brought 
about an outbreak of manifest disease (evident or clinical 
tuberculosis). If the germs are thus able to assume 



52 LESSONS ON TUBERCULOSIS 

the control in the lymph glands, but are unable to make 
further headway, the result is evident glandular tuber- 
culosis — formerly termed * ' scrofula. ' ' Because the 
germs enter the lymph glands soon after they are taken 
into the body, this form of the disease is relatively com- 
mon in childhood — less so during later years. 

If, however, for any reason, the germs should slip by 
the lymph gland barriers, they will be swept onward in 
the lymph and blood streams until, in some part of the 
body, a soil adapted to their requirements is reached. 
If they pass these barriers during childhood, the bony 
structures of the body (which at this time are compara- 
tively soft and non-resistant) will not unlikely furnish 
the soil qualities suited to the germs. In this case, bone 
or joint tuberculosis — the " white swelling' ' of former 
years — will develop.* 

Again, the germs may find in the lungs favorable con- 
ditions for their growth. Should the germs lodge in 
these organs during the earlier years of life, while the 
resistance is still at a low ebb, the resulting outbreak of 
the disease will probably be of an acute, severe char- 
acter, and in its onset may resemble pneumonia quite 
closely ( i ' galloping ' ' or ' * hasty ' ' consumption ) . Should 
the outcome of the attack prove favorable, improvement 
will set in ; but complete recovery probably will not take 
place at this time. Instead, the type of the disease is 
likely to undergo a gradual change into the ordinary, 
milder and more curable, chronic form of tuberculosis. 

In recent years a vast number of painstaking investiga- 
tions conducted from widely different angles have proven 



* Lest what has been said in the last two paragraphs give 
rise to misunderstanding 1 , let it be explained that not all chronic 
enlargements of the lymph glands are due to tuberculosis, nor 
is every case of "white swelling" due to this cause. Without go- 
ing into detail, ft should be made plain that altho tubercu- 
losis is a frequent cause of these conditions yet other diseases 
frequently operate to produce chronic enlargement of the lymph 
glands, and bone and joint disease of the "white swelling" type 
is not rarely due to some other cause. 



HOW TUBERCULOSIS IS SPREAD 53 

beyond a doubt that in many (at least a majority) of the 
cases of tuberculosis apparently originating in adult life, 
the seeds are in fact implanted in the body during child- 
hood. There they rest, in an inactive or latent state, 
until at some future date (ordinarily between the 
fifteenth and thirty-fifth year) some circumstance arises 
that weakens the protective forces of the body or in- 
vigorates the germs,* permitting them to get so firm a 
grasp upon the individual that noticeable symptoms oc- 
cur. (Oddly enough, Nature has greater difficulty in 
disposing of the original invaders that entered the body 
in childhood than in disposing of germs freshly taken in. 
The explanation is that the bacilli causing the original 
infection have had time to become adapted to their new 
environment and to develop weapons of their own against 
those of Nature. On the contrary, bacilli just taken in 
are unprepared to meet the new conditions and are more 
easily overcome.) 

• It has been noted that in many cases of undoubted tuber- 
culosis tubercle bacilli can not be found in the sputum even by 
repeated examinations, and this very naturally led to the belief 
that the bacilli must at some time undergo a change whereby 
they lose their ordinary characteristics and peculiar staining 
properties to take on entirely different characteristics and prop- 
erties, in which stage they are unrecognized by present methods. 
This has led to careful investigations, with the result that certain 
research workers, notably Ferran, of Spain, have come to believe 
that in their life cycle the tubercle bacilli undergo a process of 
mutation, passing through several evolutionary phases, and 
that only at times are they very virulent or* harmful. According 
to this view, bacilli which at the time are harmless are often 
taken into the body during the earlier years of life, and tho 
remaining apparently dormant for years, yet as they become 
adapted to their new surroundings they actually . undergo a 
gradual transformation with the acquirement of increased viru- 
lence — thus accounting for outbreaks of manifest tuberculosis 
in adult life. 

This explanation points the way to early treatment which aims 
to prevent the disease, tuberculosis, by destroying the bacilli or 
increasing the bodily defenses against the bacilli in the most 
vulnerable period of their life cycle — during childhood. 

Vaccines, said to be prepared from bacilli during a harmless 
phase, have been devised, and it is not unreasonable to believe 
that by the use of these preparations protection may be afforded 
against more virulent bacilli. However, it is at present too early 
for the formation of definite conclusions as to the value of 
preparations of this type. 



54 LESSONS ON TUBERCULOSIS 

Precautions Necessary at All Ages 

Lest the foregoing remarks be construed as implying 
that precautions are unnecessary after the first few years 
of life have been safely passed, let the point be empha- 
sized that there is some chance of acquiring a primary in- 
fection during adult life. It should be remembered 
also, that, even tho the body already harbors an in- 
fection (either dormant or progressing), it would be folly 
to run the danger of adding fuel to the fire by carelessly 
allowing further tubercle germs to enter the bpdy. More- 
over, if it is borne in mind that the great majority of 
civilized human beings are infected during childhood, one 
sees the importance of endeavoring to so live throughout 
the entire life span as to keep the resistance always at 
the maximum — to prevent the smoldering infection from 
flaming up into an outbreak of manifest disease. 



LESSON III 

HOW TO PREVENT TUBERCULOSIS 

In this lesson the knowledge gained from a perusal of 
Lesson II will be translated into practical rules. Conse- 
quently, if anything that appears in these pages is not 
perfectly clear, the meaning will probably be made plain 
by referring to Lesson II. 

Simple Precautions May Save Untold Misery 

The watchword in the crusade against tuberculosis 
should be prevention; for by the use of a little foresight 
and preparedness, untold suffering, years of blighted use- 
fulness, life and fortune, may be saved. 

Happily, the antidote to the onsweep of the disease is 
simple — moderate, tho continual, attention given to 
apparently trivial matters, usually sufficing to protect 
one. In general, the methods of prevention fall under 
two heads: (1) Those adapted to the destruction of the 
seeds of the disease, and to the avoidance of their im- 
plantation within the body. (2) Those that strengthen 
the body and build up its resisting power, so that if per- 
chance large numbers of the seeds be taken in, they will 
fall on stony soil and not take root. Furthermore, the 
endeavor should be to avoid all things that experience has 
shown serve to render the soil fertile. As the subject 
unrolls, one will see what these influences are. 

The safeguards herein described are useful not only in 
guarding one against the acquirement of the merest trace 
of tuberculosis, but are equally effective in preventing the 

55 



56 LESSONS ON TUBERCULOSIS 

relatively benign trace from developing into the manifest 
disease. They will also prove effective in preventing 
' 'closed' ' tuberculosis, which offers no menace to others, 
from progressing into the dangerous "open" type. 

It is important that the measures of prevention be put 
into effect immediately after birth. However, if this is 
not done, they should be instituted during later years, 
and at all events should be continued throughout life. 

Excessive Fear of Tuberculosis versus Common 
Sense 

How often one runs across a person who has so great 
a horror of tuberculosis that he dreads to associate with 
a victim of the malady for even a short time, or has an 
almost fanatical fear of contracting the disease through 
the inhalation of germ-laden dust on the street. There 
is no sound basis for this unreasonable and foolish 
fear. The disease is not "catching" in the same sense 
that measles and scarlet fever are "catching"; that is 
to say, tuberculosis is not acquired through casual or 
temporary contact or near-contact with a victim of the 
disease. It is seldom transmitted except by a long and 
intimate association of weeks or months; even then, 
there is no danger unless the disease has progressed to 
the communicable "open" stage, and in addition, the 
afflicted person be careless in the disposal of the sputum. 
Altho every reasonable precaution should be taken, 
particularly during childhood, and while association with 
a careless victim of "open" tuberculosis is to be avoided 
at all cost, the tendency to shun the afflicted person who 
is careful and considerate of the rights of others is an 
unnecessary cruelty. 

"Those Who Live in Glass Houses." There is a cer- 
tain type of individual, himself suffering from what he 
believes to be "weak lungs," "catarrh," "asthma" or 



HOW TO PREVENT TUBERCULOSIS 57 

the like, who looks upon his neighbor who has openly 
stated that he is afflicted with tuberculosis, with a sort 
of holy horror. Such a person, unknown to himself per- 
haps, actually suffering from advanced tuberculosis and 
unwittingly scattering its seeds far more widely than 
his better-informed and more careful friend, would there- 
fore do well to put into practise the Biblical advice of 
searching out the mote in his own eye. 

Answering a Common Query. Into the minds of 
those who realize (as described in Lesson II) that so 
long as tuberculosis continues to exist, the taking in of a 
few bacilli from time to time serves a useful purpose — 
each germ successfully combated by the body adding just 
that much more to its store of fighting power — there 
sometimes comes the question, Is it advisable for an at- 
tempt to be made to destroy all the seeds of the disease 1 

The answer is: Yes; very much so. Everyday risks 
make the taking in of a few tubercle bacilli almost cer- 
tain ; so one may use all reasonable precautions against 
infection and make every effort to do away with the 
germs, with the assurance, notwithstanding, that the 
minimum doses of bacilli necessary for protection will 
almost surely be acquired. 

Safeguards fob Children 

Altho the seeds of tuberculosis are scattered broadcast 
almost everywhere lying in wait for the infant, their 
implantation within the tender body can usually be 
averted if the parents are awake to the peril. Precau- 
tions are all the more essential if the father or mother is 
a victim of the malady. Lest their heartstrings be wrung 
by a late realization of duty neglected, they should make 
the most of every means to guarantee their dear one its 
complete allotment of strength and health until it is 
old enough to look after its own: interests. They should 



58 LESSONS ON TUBEECULOSIS 

remember that largely in their hands lies the decision as 
to whether the youngster is to be given an even start 
in the world — a start that will put him on a footing of 
equality with his competitors — or whether he is to go 
through life handicapped by a health unnecessarily 
ruined at the outset. 

In a word, this means simply that from birth on the 
child should be raised properly, guarded carefully, and 
so fortified that it will be given the best chance for 
withstanding such accidents and diseases as inevitably 
occur. 

Especial Watchfulness Needed at Time of Puberty 
and Adolescence. Protection is necessary at all ages, 
but at the time of puberty and adolescence watchfulness 
should be increased. When youth begins to find itself, 
and when the boy and the girl enter the domain of 
manhood and womanhood, are times of special danger — 
periods when the first breakdown in health is liable to 
occur. As the young man and young woman experience 
the first real glow of life, they are apt to feel competent 
to do almost anything ; bubbling with life, they wish to 
try themselves. Ambition and uncontrolled impulses 
may at this time easily lead them into many harmful 
adventures. With gentleness and firmness tinctured 
with patience and tactfulness, parents may curb these 
tendencies of their loved ones. 

Protection Not Synonymous with Coddling. On 
the one hand, the parents should be on the alert to de- 
tect the earliest symptoms of disease, in order that more 
rigid measures may be instituted ; on the other hand, it 
is important that the safeguards be put into effect in 
such manner as will avoid "spoiling the child/ ' thus 
making him into an oversensitive, fearful and nervous 
being, afraid to depend upon himself for anything. In 
keeping with this advice, it will be shown later that pro- 
tection is by no means synonymous with coddling. 



HOW TO PHEVENT TUBERCULOSIS 59 

Food for the Growing Body. Nutrition is the back- 
bone of resistance ; so from babyhood on, no pains should 
be spared to see that the child has the best of simple, 
nourishing food. 

Mother's Milk Best, Unless for Special Reason. Be- 
cause no man-made food can satisfactorily take the place 
of that supplied by Nature, it is essential that the infant 
be nursed by the mother — if she is healthy ; if sick, for 
the good of both mother and infant, some other plan 
should be arranged. 

If obtainable, a wet-nurse is then perhaps the best 
solution of the problem. It goes without saying that 
such a nurse should be selected with great care, and that 
a health certificate should be demanded of her. 

The Dangers of Impure Cow's Milk — Goat's Milk. 
Clean, pure dairy milk, properly diluted and modified,* 
is ordinarily the next best substitute for mother 's milk. 
In passing, it may be noted that goat's milk has one 
great advantage over cow's milk, in that it seldom serves 
as a vehicle for the conveyance of tuberculosis — goats 
rarely contracting this disease. On the contrary, cows 
are very frequently afflicted with tuberculosis, and con- 
taminated milk is an important medium for the trans- 
mission of the disease, especially in childhood. (The 
danger of acquiring the disease by eating the meat of tu- 
berculous cattle is comparatively slight.) Moreover, 
goat's milk is unusually rich, and analysis has shown that 
it bears a closer resemblance to the human breast milk 
than does cow 's milk, while experience has demonstrated 
that goat's milk is likely to be more easily handled by 
delicate stomachs. Incidentally it may be added that 
goat's milk does not have a strong, repellant odor or 
taste, as many suppose. 



* In some cases, one of the prepared food mixtures, such 
as Dennos', Nestle's, Eskay's or Mellin's Food may be used to 
advantage in modifying the milk. 



60 LESSONS ON TUBERCULOSIS 

The Source and Care of the Milk. In most com- 
munities, however, cow 's milk is the only practical milk 
for general use ; and, if uncontaminated, gives fairly good 
results. Milk from tuberculin tested cattle, certified 
milk, or milk that has been pasteurized (heated to 140°- 
160° F. and maintained at this temperature for one-half 
hour), should be obtained, if possible. Unless the source 
of the milk is known to be right — that is, unless the cow 
not only appears healthy, but has actually been proven 
free of tuberculosis — and unless the conditions connected 
with the collection, storage and distribution of the milk 
are known to be good — milk from a herd of cattle is 
safer than milk from one cow. Milk from a single source, 
if contaminated at all, is dangerously contaminated; in 
" mixed milk" on the contrary, the injurious influence of 
one sick cow may be largely counteracted by the effect 
of dilution with the pure milk of other-cows. 

Other Substitutes for Mother's Milk. When satis- 
factory fresh milk cannot be obtained, dried, evaporated, 
or condensed milk may be used. 

In the last few years, investigations and experience 
have proven that while condensed milk is not the most 
desirable food for the child, yet it is a much better food 
than was formerly supposed. Heating or even boiling 
the milk, a process incident to its manufacture, instead of 
rendering it more difficult of digestion, as was previously 
assumed, has been shown to really facilitate digestion. 
Nevertheless, heat injures certain principles in milk that 
are especially vital to the health of the child — vitamines 
(more fully discussed in Lesson X) ; moreover, the con- 
stipating effect of milk is increased by heating it. For 
these reasons, milk should not be heated unless absolutely 
necessary. Furthermore, as a precautionary measure to 
offset the detrimental effect of heat on the vitamines, chil- 
dren raised upon evaporated, condensed, or heated milk, 



HOW TO PREVENT TUBERCULOSIS . 61 

should be given fruit juice of some sort, such as orange 
juice, regularly each day. 

Formerly, much of the injurious effect of condensed 
milk was attributed to the large percentage of sugar it 
contained. Nowadays, however, in the many brands of 
unsweetened evaporated milks on the market, one is 
offered a wide selection of excellent milks, almost any 
one of which, when properly diluted and modified, 
furnishes the various ingredients in proportions more 
nearly corresponding with the needs of the young body. 

Every effort should be made to provide the youngster 
with fresh, sweet milk, and in many communities ar- 
rangements have been made for supplying wholesome 
milk to the poor at public milk stations, entirely free of 
cost. But for those who cannot obtain satisfactory fresh 
milk, or who have no way of keeping the milk in good 
condition, evaporated or condensed milk may prove a 
blessing. (Evaporated goats' milk is also to be had, and 
is to be preferred in certain cases.) 

Because of its lesser content of sugar, etc., evaporated 
milk is ordinarily more healthful and as a rule should 
be given the preference over condensed milk. However, 
when it is necessary to keep the milk for several days or 
longer after opening the can, and as a matter of con- 
venience on long journeys, the thicker condensed milk 
may be best. 

Dried milk or milk powder is another convenient 
preparation of merit when fresh milk is not to be had. 
Dried and evaporated milks have somewhat the same 
objections and advantages, tho the milk powder is 
perhaps less constipating and retains a larger quantity 
of vitamines. In appearance and taste the milk mixture 
prepared from a dried milk powder is more like fresh 
milk than is evaporated milk ; but the preparation of the 
product is somewhat more troublesome. 



62 LESSONS ON TUBEECULOSIS 

A Loathsome and Dangerous Habit. Unfortunately 
there still exists in some quarters the habit of feeding 
the child food that has been previously chewed by the 
mother or other person, so a forcible warning against 
this loathsome custom becomes necessary. Under no 
circumstances whatever should anything be allowed in 
the mouth that has been in the mouth of another person, 
either child or adult. Nor should the food of the child 
be cooled by blowing the breath upon it. 

From early infancy the little one should be taught to 
put nothing in its mouth but food or drink ; later, as it 
grows in knowledge, its broadening mind may be imbued 
with the truth that swapping apple-cores and putting 
pencils, money or other objects in the mouth are de- 
cidedly dangerous. 

Separation from the Sick Essential. The infant 
should not remain with the sick mother, or near others 
who are ill. It should be kept well separated from the 
sick — in another room if possible — and should be cared 
for by a well person. 

If the family's means be so limited that suitable con- 
ditions and care for the baby cannot be provided in the 
home, the mother can sometimes best show her love by 
allowing the little one to be removed entirely from her 
for a time. It may be that a Children's Home or Chil- 
dren's Hospital, or even better, a Tuberculosis Preven- 
torium, is near at hand, or that some private home is open 
to the infant, where it will be sure to receive good care. 
Later, when her dearest treasure is returned to her, the 
mother's first glimpse of the happy face, wearing the 
bloom and vigor of health, will fill her heart with joy and 
a feeling of great gladness that through a willingness to 
make a sacrifice and to accept temporary deprivation, 
she has saved her darling from a life-long handicap. 
More : Owing to the fact that the mother has had a rest 



HOW TO PREVENT TUBERCULOSIS 63 

from the care of the child, she now finds herself able to 
give the little one many attentions which in her former 
condition she was totally unable to give. As the mother 
continues to improve and the infant buds out into the 
child, the love-bond that joins them becomes more and 
more firmly knitted. 

Life Under Nature's Canopy 

Too many children, brought up like hot-house plants, 
starving for air, wilt and fade just as they should be 
blossoming out into glorious young manhood and woman- 
hood. If there is one thing every growing youngster 
needs in large quantities, it is plenty of fresh air. From 
its earliest years, the child should be encouraged to spend 
a large part of its time out of doors. Fresh air is just 
as important for the infant as for older children, but of 
course more care is required in accustoming the very 
young and delicate form to atmospheric changes and 
the like. An outdoor sleeping room and day nursery, so 
equipped with adjustable curtains or similar devices as 
to furnish reasonable protection from extreme cold, strong 
drafts, and from direct intense sunshine, where the lit- 
tle tot may sleep and later play, will mean much for its 
future welfare. Unless the weather be inclement, the 
baby should be wheeled daily into the open. 

Outdoor Recreation and Moderate Exercise a Neces- 
sity. As the child grows and thrives, mild outdoor 
recreation that does not require violent exercise should 
be found for it. For example, a sand pile, which holds 
strong allurement for many of the little folks, may be 
provided at small outlay, to which other suitable attrac- 
tions may be added, thus furnishing a form of amuse- 
ment that is nearly ideal — one that has been worth 
almost its weight in gold to many a one-time young tu- 
berculosis candidate. 



64 LESSONS ON TUBERCULOSIS 

Unless the child be afflicted with evident or manifest 
tuberculosis (a definition of these terms may be found 
in Lesson I, p. 31), exercise in moderation is a necessity, 
if it is to develop that ruggedness of health which is to 
serve it as an efficient bulwark against disease. When at 
play, it should be guarded carefully against overexer- 
tion, and should be taught to take frequent periods of 
rest. Parents should never lose sight of the fact that 
at best, the fund of resistance of the little tad is small ; 
they should therefore spare no effort to prevent the bub- 
bling and exuberant youngster from drawing too heavily 
on this rather meager account. 

Indoor amusements such as moving pictures, which 
are almost invariably associated with "bad air" and 
other injurious elements, are to be avoided by all who 
are predisposed to tuberculosis. 

Clothing for Children 

The modern tendency is to burden the body with too 
heavy clothing. This is especially true during the sum- 
mer. While enough clothing should be worn to insure 
adequate protection, the matter should not be overdone. 
Excessive clothing makes the child so dependent on arti- 
ficial protection that when it meets with unavoidable ex- 
posure, it is much more liable to be injured than if it 
had previously been accustomed to a minimum amount of 
clothing. Thus the very object for which one is striv- 
ing — the development of a sturdy body that will resist 
disease — is defeated ; and in fact, the opposite condition 
(predisposition) is cultivated, which only too well fits the 
child as a candidate for all manner of ills. 

Cold Sponging as a Body-bracer 

After the first few years, or even earlier in suitable 
cases, daily cool sponging of the body of the child (ac- 



HOW TO PREVENT TUBERCULOSIS 65 

cording to the directions given in Lesson XV) will 
greatly help to strengthen and invigorate it. 

If the child be gradually accustomed to light clothing ; 
if with this, cold sponging of the body and the open- 
air life be wisely combined, then after a reasonable 
trial one will often be most agreeably surprised at the 
change in outward /appearance and the amount of 
hardening and resistance to exposure and disease which 
has been acquired by the now hardy youngster. 

Ills of All Kinds to Be Avoided 

Every means should be used to shield the child from 
all diseases, including even the very ordinary ailments. 
The young body is no longer looked upon as the legiti- 
mate prey of disease, and the old custom of accepting 
the illnesses of childhood as inevitable heritages, as 
exemplified by the saying, "Oh, he might as well have 
it now as later," has given way to the understanding 
that these outwardly mild disorders are in fact decided 
evils, which may result in great and permanent harm. 
Fortunately, it is also now recognized that in many cases 
it is possible to ward off these sicknesses throughout life. 
Among those that are especially to be guarded against 
are measles, whooping-cough, la grippe and pneumonia, 
as they too often prepare the child for an outbreak of 
tuberculosis. The common cold, too, is no longer de- 
spised, but is rather to be shunned as a forerunner of 
more serious disease. 

Care of the Mouth, Nose and the Throat. Modern 
science has shown that in one way or another, unhealthy 
conditions of the mouth, the nose and the throat at 
times play an important part in the development of 
tuberculosis. In some cases there are hidden pus pockets 
in these parts, from which seeps out an insidious poison 
that gradually undermines^ the health; sometimes the 

5 



66 LESSONS ON TUBERCULOSIS 

harm is wrought in other ways : whatever the manner, it 
is imperative that a healthy state of these organs be 
maintained. Sometimes the trouble lies in or surround- 
ing the roots of the teeth, and is only revealed by a care- 
ful examination in which the X-ray plays a part. The 
teeth should assiduously be kept clean, and repaired when 
necessary. In keeping with this endeavor, parents should 
not forget that an early dollar in the dentist's pocket 
may mean many dollars in one's own pocket later. The 
nose and throat also are sources of considerable danger. 
Enlarged turbinate bones or other forms of nasal obstruc- 
tion, and disease, such as catarrh, should receive prompt 
attention from the expert. 

What Is to Be Done with Diseased Tonsils? Dis- 
eased tonsils are an especially fruitful source of illness 
and should receive proper treatment. In this connec- 
tion, the fact should be kept before one that when in 
healthy condition, these organs are strong links in Na- 
ture's system of defense against disease (as described in 
the preceding lesson). It is then highly important that 
they be left alone. On the other hand, tonsils that are 
seriously and chronically diseased, and adenoids (com- 
parable to fortresses that have fallen into the hands of 
the enemy) serve to smooth the path for the advance of 
disease, not only indirectly by sapping the vitality, but 
by providing open gateways through which the germs 
of tuberculosis may enter the body. In this case, having 
lost their usefulness as guardians of health, unless there 
be some reason why the operation should not be per- 
formed, it is just as essential that these breeding pits 
and obstacles to health be promptly removed. 

It is well to emphasize the fact that tonsils that en- 
danger health are not necessarily of the large, protruding 
variety. As a matter of fact, some small ' 'buried' ' 
tonsils are in worse condition than others that project 



HOW TO -PREVENT TUBERCULOSIS 67 

far into the throat, and the need for removal of such 
" hidden' ' tonsils may be even more urgent. 

Fortunately, to-day, in many cities, routine physical 
examinations are made of all children of school age. In 
this way many a youngster whose parents were pre- 
viously unsuspicious that the health of their dear one 
was mortgaged by adenoids or crippled tonsils, have had 
the encumbrances removed in time to give him a clear 
title to health. 

If the child is subject to recurrent attacks of ton- 
sillitis, the operation is usually more safely performed 
between attacks. It is essential that the operation be a 
thorough one — that the tonsils be not merely clipped off. 

A Gratifying Transformation. In many instances, 
as a result, the young patient undergoes a remarkable 
and sometimes astonishingly rapid transformation. When 
the anxious and love-hungry parent sees the hitherto dull, 
backward, and rather sickly youngster begin to brighten 
and show an interest in things, developing an ability to 
grasp matters that were formerly beyond his range; 
when at the same time he sees the pale, wan face take 
on the rosy tint of health, he is glad indeed that through 
his foresight the youngster has come into his own. 

School Days 

When the child reaches the school age, it should if pos- 
sible be sent to one of the schools held mainly in the 
open air,* now rapidly springing up in many parts of 
the country. These schools, suitable for all children, but 
adapted especially to those who are delicate, where study 
is wisely combined with periods of rest, offer the child 
who is predisposed, or who has a trace of tuberculosis 

• For information regarding open-air schools and fresh-air 
classes in the various states, correspondence is invited with the 
Elizabeth McCormick Memorial Fund, 315 Plymouth Court, 
Chicago. 



68 LESSONS ON TUBERCULOSIS 

but who is not evidently sick, the best chance of obtaining 
an education and at the same time building his frail body 
into a strong and robust one. (In Lesson V, p. 99, may 
be found the answer to the question : In what cases will 
mere preventive measures suffice, and when does definite 
treatment of the disease become necessary?) 

A Mistake to Force the Delicate Child Through 
School. Under no circumstances, should the delicate 
child be forced or hurried through school. All work 
and no play not only makes Jack a dull boy, but may so 
light up the smoldering fires of tuberculosis that years 
are passed by the anxious parents in bitter regret that 
they failed to look ahead a little, ere they see the flame 
extinguished. Is it not better that the little one start in 
a little late and lag behind somewhat, than that he be 
compelled to stop prematurely, and come out minus his 
health? Although knowledge is valuable indeed, yet a 
little less education means no serious loss ; at all events 
there remains the chance that the loss may be made up 
when health is obtained. On the other hand, what is all 
the knowledge in the world worth to the child who is an 
invalid and cannot use it? 

Vacation Time. The young tuberculosis prospect 
should spend his vacations in a comparatively quiet, 
easy life out of doors, entirely free from work* and 
study. Love of nature should be encouraged. A change 
of scene, a visit to the country, a camping trip or a 
leisurely tour in the auto, in which the youngster takes 
mainly a passive part, will often help to instil in his 
mind a love for the out-of-doors, and will do much toward 
making over the weak body. 

* The elimination of child labor is one of the most important 
measures of prophylaxis. With the resistant forces of the body 
already naturally low, and the chance for acquiring- relatively 
large doses of virulent tubercle germs unduly high (during child- 
hood — as explained in Lesson II), to lessen the protective forces 
still further at this time through regular day labor should be 
considered a crime. 



HOW TO PREVENT TUBERCULOSIS 69 

Again, a change of climate may be sought. (In some 
instances, removal to a healthier locality for an indefinite 
period is best. This point will be covered more fully in 
Lesson XII.) 

The Danger of Overstudy. It is a strange truth 
that the boy or girl who is blessed by Nature with a 
strong body and who perhaps has an exceptional need 
for education, is often but a dilatory student; whereas 
the young man or young woman with body cast in deli- 
cate mold, veritably unfitted for the cramped and con- 
fining indoor life of the knowledge seeker, is ofttimes 
inclined toward excessive study. How many there are 
whose whole future has been warped and ruined by too 
much mental concentration during their high school or 
college years! Too often, the rather headstrong young 
man or young woman fails to take the cautionary word 
of advice seriously; yet in many cases parents can do 
much toward restraining a tendency to overstudy. 
Surely it is their duty to bring into play whatever in- 
fluence they can exert in this respect. 

Judicious Exercise Versus Violent Sports 

Carefully Graded Exercise Sometimes Advantageous. 

There is no doubt that when wisely and moderately ap- 
plied in appropriate cases, calisthenic or other carefully 
graduated exercises will quite often accomplish wonders 
toward strengthening and stiffening the physique. On 
the other hand, it is important for it to be understood 
that if the young person be already a victim of slumber- 
ing or of active, evident tuberculosis (which, perchance, 
may be unrecognized), it is not at all unlikely that such 
exercise, instituted with the hope of benefit, may serve 
only to fan the fire into leaping flame. For this reason, 
gymnastic exercises should not be taken up by persons 
thought to be merely predisposed except with exceeding 



70 LESSONS ON TUBERCULOSIS 

caution ; and usually should not be undertaken at all ex- 
cept on the order of, and under the guidance of, an 
understanding physician. 

The Hazards of Violent Sports. Violent sports, on 
the other hand, are to be decidedly frowned upon. I 
wish there could be blazoned forth a general warning 
against indulgence in strenuous athletic contests, more 
especially against those that call for a pronounced de- 
velopment of the "wind." These games and sports con- 
tain unseen perils for all, but are especially hazardous for 
those who are short on physical equipment. As a result 
of such unnatural activities, there takes place an over- 
development of the heart and lungs. Sometimes the too 
heavy demand upon these organs results in an almost 
immediate breakdown. In other cases, nothing out of the 
ordinary is noticed at the time ; at the end of the school 
or college years, however, when, as the young person 
settles down, the intense physical activities are suddenly 
dropped, the previously overstimulated organs are liable 
to degenerate. Too frequently "athlete's heart" or tu- 
berculosis is the sequel. 

Choice of Occupation 

From a health standpoint, the essential guides in choos- 
ing a calling are that the labor be comparatively light, 
and that the work be carried on under sanitary condi- 
tions. 

In keeping with these principles, the fact deserves em- 
phasis that intense mental application may put a greater 
drain on one's resources than would a reasonable amount 
of physical labor. Thus, it is apparent that the quite 
common advice proffered to delicate persons to seek some 
vocation that requires mainly brain work, or to enter 
one of the professions, is sometimes based on error. 
True, such employment is exactly suited to some of these 






HOW TO PREVENT TUBERCULOSIS 71 

individuals, especially to those who are peculiarly fitted 
through taste, talent, extraordinary opportunity, or the 
like, for one of the so-called learned callings. Yet the 
fact should be kept before one that the work connected 
with these vocations is not nearly so light as many sup- 
pose; and that, furthermore, the confining or irregular 
trend of life usually closely linked with work of this 
nature, plus the near-necessity for almost continual 
mental "digging," if one is to remain at all near the 
vanguard, unite to produce a heavy demand upon the 
capacities. If these observations are kept in mind, one 
will be less likely to make the mistake of selecting some 
occupation that calls for almost purely mental labor 
through basing the choice almost wholly on the assump- 
tion that such work is necessarily more healthful. 

No universal rule can be laid down. The endeavor 
should be to take into account all related factors in each 
case, and let the decision be governed accordingly. In 
reaching a final conclusion, it should not be forgotten 
that, other things being equal, an outdoor occupation is 
best, and that, in connection with indoor work, the fac- 
tors of light and ventilation and the question of dust or 
noxious fumes, etc., are among the important items to be 
weighed. 

On Taking a Vacation 

Every individual should include in his creed of living 
the fixed rule that, unless absolutely impossible, he will 
seek complete rest from work for not less than two weeks, 
at least once yearly. Everyone knows that one cannot 
continue indefinitely to run with the throttle wide open, 
without paying the price; yet how many attempt to do 
this very thing — of ttimes just to get ahead a little faster 
than the other fellow! Do not, then, allow yourself to 
become so engrossed in your work that you cannot once in 



72 LESSONS ON TUBERCULOSIS 

a while lift up the yoke and find relief in rest and 
recreation. 

Habits 

By adhering strictly to the principle of regular and 
moderate living, many a promising candidate for tuber- 
culosis, tho additionally hampered by unhealthful 
working conditions, has succeeded in obtaining and main- 
taining vigorous health. He who cultivates the habit of 
promptness at meals, who observes a definite schedule for 
sleep, who makes sure that his bowels move at proper 
intervals (for the average individual, this means at least 
once daily), will be taking a long step toward health 
conservation. 

All excesses should be avoided, the aim being to do 
nothing that noticeably or materially reduces strength. 
Along this line, a word of caution against dancing seems 
in order. The feeling of keen exhilaration that so com- 
monly accompanies this form of recreation, has in many 
instances caused the dancer to overestimate his strength ; 
until, led repeatedly to exceed his limit, he has gradually 
been carried along to his complete undoing. 

The Use of Tobacco. Save from the standpoint of 
pastime or pleasure, it must be confessed that except in 
those less common cases in which the habit has obtained 
an almost unbreakable grip on one, or in other excep- 
tional circumstances, the use of tobacco in any form 
serves no good purpose. Some men are never materially 
harmed by the moderate use of the weed ; yet for others 
it is an insidious poison that directly or indirectly lays 
the foundation for disease. It is obvious, therefore, that 
those who wish to take advantage of every opportunity 
for guaranteeing health, will not contract the habit. 

The Use of Alcohol. Far from fortifying one 
against tuberculosis, as some persons think, alcohol tends 



HOW TO PREVENT TUBERCULOSIS 73 

to strip the body of its normal defensive power against 
disease. As a matter of fact the drink habit offers one of 
the easiest ways to acquire tuberculosis. Alcohol has met 
its Waterloo in this country and is tottering on its throne 
in other parts of the world, yet there may still be some 
persons who contemplate the salvation or redemption of 
health through drink. These should never forget the 
old saying that " Alcohol makes the bed of the consump- 
tive.' ■ 

Marriage and Tuberculosis 

It has long been known that love and logic often fail 
to agree. It may very well be that a word of caution 
against the hasty assumption of the marriage obligation 
will in many instances fall on deaf ears. I have, how- 
ever, an abiding conviction that there are many who 
wish to see clearly ere they leap; not alone for them- 
selves, but that they may scan closely the future of the 
unborn. To these the following remarks are addressed : 

A Matter That Should Be Looked Upon from All 
Sides. Marriage imposes an unusually heavy demand 
upon the wife and, to a less degree, upon the husband. 
For one who has shown symptoms of manifest (evident) 
tuberculosis, even tho only in the incipient stage, mar- 
riage is almost never to be seriously thought of until 
the disease has been firmly arrested for several years; 
even then, after apparent complete recovery, one should 
consider well before taking this step fraught with con- 
sequences of tremendous import. Bearing in mind the 
common sequel, conception,* the probable effect of such 
an event upon the health of the wife should be given 
due consideration. In addition, careful thought should 
be given to the following questions : — 

• To the suggestion that one marry and give up all thought of 
having children, the answer is: No; for a pregnancy is very 
likely to occur despite all intentions to the contrary. To cherish 
the belief that it will not is a serious mistake that may lead to in* 
tense regret. 



74 LESSONS ON TUBERCULOSIS 

Has one the right to enter a relationship that one 
knows will probably result in bringing into the world a 
being already weakened, and liable to be unfairly smitten 
near the very beginning of its career ? Is not the heritage 
of a strong body due every child ? Is it not the duty of 
those who think of marriage to weigh thoroughly the 
consequences ere they assume an obligation that may rob 
the most precious possession of the home in the enjoy- 
ment of this right ? 

The Risks of Pregnancy. In the first place it should 
be thoroughly understood that for tuberculous persons 
the sexual act, and particularly sexual excess, have dis- 
tinct and decided dangers of their own. These will be 
fully discussed in Lesson VIII. Yet there are other 
things even more important for those having marriage 
in view to understand. It should be stamped indelibly 
upon the forefront of the memory that childbirth, 
especially if repeated, and the nursing and rearing of the 
little ones, put an extraordinary and very severe strain 
on the tuberculous mother. The old belief that the bear- 
ing of children was a cure for consumption, has under 
the torch of experience and knowledge given way to the 
understanding that childbirth and the care of the new- 
comer more often breed tuberculosis. The hazard is 
as a rule greater during the first few years of married 
life, or until the wife has become thoroughly accustomed 
to her new duties — and in some cases, trials — and until 
the circumstances of the couple have become fairly easy. 

After all, no one rule will apply to all cases. Whether 
the conclusion be based mainly on the molding of one's 
children's future, or on one's own welfare, in the end 
the settling of the matter often depends partly on other 
considerations, among which the state of one's finances, 
the temperament of both parties, and the willingness to. 
make self-denial and sacrifice for the good of one's mate, 
are important factors. 



HOW TO PREVENT TUBERCULOSIS 75 

A Momentous Question. On the other hand, when 
a woman already pregnant discovers that she has tuber- 
culosis, she should receive the greatest sympathy and 
consideration. It may comfort her to know that the 
law does not forbid the premature interruption of 
pregnancy to preserve life, tho a matter of such im- 
port can be decided only after the most earnest and 
solemn thought on the part of the married couple in 
conjunction with their spiritual and medical advisers. 

Should pregnancy continue, every means that may 
lighten the burden of the expectant mother should be 
employed. At the time of childbirth an anesthetic 
should be given or "twilight sleep' ' induced, and the la- 
bor terminated by artificial means as soon as advisable. 
The sick mother should not nurse the infant, she should 
be relieved of its care, and it should be kept away from 
all sick persons. 

Precautions for the Sick 

Need for Extra Precautions Under Certain Circum- 
stances. In all cases the person ill of tuberculosis 
should make use of every known method of safeguarding 
the health of others, but precautions are even more es- 
sential under certain circumstances. Altho, as previously 
noted, tuberculosis is not usually contracted during adult 
life, yet owing to the continual and intimate character 
of the relationship that exists between husband and wife, 
if one or the other be afflicted with tuberculosis, the 
chance that one's mate will acquire the disease is con- 
siderable, if reasonable precautions be neglected. In 
such cases, and when there are children in the home or 
near the sick person, all measures should be applied with 
extraordinary thoroughness. 

General Rules. The patient should sleep alone, pref- 
erably in a separate room, which in suitable cases may 



76 LESSONS ON TUBERCULOSIS 

be quite distant from the general living or sleeping 
quarters; at all events no well person should sleep 
within four feet of the sick. Kissing or fondling should 
not be indulged in; and the ill person should avoid 
handling the food of others. Towels, napkins, drinking 
cups, and the like, should be kept aside for the sole use 
of the invalid. Separate tableware may also be used for 
the sick. If this plan is not followed, after thorough 
washing all dishes should be boiled, or at least well 
scalded. 

The afflicted person should be careful not to cough or 
sneeze into the face of others. A cloth or a paper napkin 
may be held in front of the face when coughing ; but this 
is almost useless unless the cloth or paper be properly 
disposed of immediately (by burning or placing in a 
suitable receptacle), ere it contaminates the body or 
clothing. The hands should be washed frequently. 

Beards, mustaches, and veils are efficient germ col- 
lectors, and should therefore not be worn. 

Care of the Sputum a Matter of Vital Importance. 
For his own protection, the invalid should never know- 
ingly swallow even the smallest particle of his sputum. 
(It is evident, however, that those who have much ex- 
pectoration are very likely to swallow a certain amount 
of the sputum while asleep. Ordinarily, this is destroyed 
by Nature or passed out in the bowel dejecta, without 
harm resulting. There is, therefore, no cause for alarm 
if a small amount of sputum is inadvertently swallowed 
at other times. Nevertheless, swallowed sputum is not 
always harmless, so it should on no account be swallowed 
voluntarily.) On the other hand, promiscuous expec- 
toration is not to be tolerated. If at any time exigency 
makes impossible the proper disposal of this dangerous 
discharge, on no account should one spit indoors upon 
the floor. If, perforce, one must spit elsewhere than in 



HOW TO PREVENT TUBERCULOSIS 77 

a suitable receptacle, let one do so in the street in a 
sunny spot where the solar rays will be given fair op- 
portunity to destroy the germs ; not in a dark alleyway, 
or down some grating or crack, inaccessible to the sun. 
The habit of spitting in handkerchiefs is both disgusting 
and dangerous. Those who are confined to bed should 
use exceeding care that they do not soil the bed clothing. 

Practicable Methods of Sputum Disposal. It should 
be understood that one is not properly protecting the 
interests of others by merely expectorating in the public 
spittoon or large sawdust containing spit-box. This is 
not enough. The sputum should preferably be collected 
in some form of individual sputum cups; and subse- 
quently destroyed before it has had time to dry and be 
blown about. 

The sputum cup made of specially treated heavy paper, 
which fits into a metal holding frame, is cheap, and is 
perhaps the most satisfactory receptacle for ordinary use. 
Patients who are up and about, may provide themselves 
with a supply of the collapsible, pocket paper sputum 
collectors. These eups, obtainable at little cost, answer 
the purpose very well, provided each is used only a few 
times. A small pledget of cotton placed in the bottom, 
helps to absorb and retain the discharge. There are sev- 
eral other forms of pocket sputum retainers on the 
market, some of metal, that are also safe ; as an alterna- 
tive, one of these may be used if so desired. 

How the Sputum May Be Destroyed. All re- 
ceptacles should be protected from flies, and their con- 
tents promptly destroyed. Paper cups should be burned. 
Care should be taken to make sure that the contents are 
completely incinerated. If sawdust be sprinkled into 
the cup occasionally, as it is used, burning will be fa- 
cilitated. Merely bringing the sputum in the cup to the 
boiling point is not sufficient (to destroy all the germs, 



78 LESSONS ON TUBERCULOSIS 

altho of course this kills many and weakens others) ; if, 
however, boiling be continued for thirty minutes, the 
process may be thoroughly relied upon. 

Chemical methods are less certain than fire or heat, 
but may be used for metal or similar containers. A two 
per cent solution of either Lysol or chloride of lime; a 
five per cent solution of carbolic acid ; or a 1 :1000 solu- 
tion of corrosive sublimate (preferably incorporated with 
other ingredients as in the commercial Bernay's anti- 
septic tablets) are among the best agents for this work. 
Note: If convenient, the cup may be kept partly filled 
with the solution ; but at all events the solution should be 
in large excess over the expectorated matter, and should 
be allowed to remain in contact with it for twenty-four 
hours before emptying.* 

Importance of Destroying All Discharges. The 
sputum is the greatest source of danger, and in many 
cases the only source ; yet in some instances, discharges 
of other character may similarly threaten the health of 
others. When there is reason to suspect that any other 
excretion or discharge holds a menace, its virulence 
should be destroyed by one of the methods just described. 

Care op the Apartments 

An abundance of light and fresh air should be con- 
stantly admitted to the rooms occupied at any time by 
the sick. In cleaning the apartments the vacuum cleaner 
or moist-sweeping, and the collection of dust with a damp 



• In the disposal of the sputum care should be used to avoid 
contamination of any open sore or cut. Local tuberculosis of 
the fingers from accidental inoculation is not very rare among 
butchers, and among physicians who do very much post mortem 
work, and while under ordinary circumstances the chance of 
acquiring an infection in this manner is not large yet cases of 
this sort have resulted in fatal general tuberculosis. In child- 
hood, owing to the fact that the child often plays on the floor 
where germs settle, the chances of a wound on the hand being 
inoculated is increased, and at this time of life the results are 
likely to be serious, facts which should serve as additional warn- 
ings against careless methods in disposing of the sputum. 






HOW TO PREVENT TUBERCULOSIS 79 

cloth or oil-mop, are much to be preferred to the older, 
broom-sweeping, dust-scattering methods. 

Fumigation Versus Simpler Methods of Disinfection. 
When the premises are vacated, before the rooms are 
occupied by other persons, they and their contents should 
be thoroughly disinfected. For this purpose, if the re- 
movable articles that are most liable to be contaminated, 
such as the bed linen and covering, be boiled or burned, 
as proves practicable in each instance ; if the woodwork 
and the like be thoroughly scrubbed with soap and hot 
water ; if the rooms be well aired and sunned for several 
days — this process will probably be more effective than 
fumigation alone, and is certainly far more trustworthy 
than is the hit or miss plan of fumigation commonly in 
vogue in the past. However, if fumigation be properly 
done, it is perhaps needless to add that the habitation 
will be safer than if only the simpler cleansing plan is 
followed. 

If fumigation is decided upon, in order that the dis- 
infection may be complete, it should be attended to by, 
or carried out under, the direction of the health authori- 
ties, or some one who thoroughly understands the matter. 
For satisfactory fumigation, it is a prime requisite that 
the rooms be unoccupied and that all cracks and open- 
ings be so sealed as to render the apartments practically 
air tight. If this cannot be done, efforts at disinfection 
by chemical means are to be looked upon as largely a 
waste of time. For the disinfection of open-air sleeping 
porches unprovided with means of temporary closure, 
therefore, the simpler and more natural agencies above 
described must be the main reliance. 

Preventive Vaccination 

It has long been the fond hope of workers in the field 
of tuberculosis to perfect an effective preventive vaccine, 



80 LESSONS ON TUBERCULOSIS 

and within the last few years a number of preparations 
devised for this purpose have been brought forward. It 
is hardly probable that at any time a preparation of 
this nature will be perfected to the point of conferring 
absolute or complete protection against tuberculosis — 
against massive germ dosage — or that a single vaccina- 
tion or one course of inoculations will afford protection 
throughout life ; but if protection is secured during the 
earlier years of life a great stride forward will be 
recorded. Sufficient time has not elapsed for the accurate 
evaluation of the vaccines now in use, but there are 
several such preparations which can be given with safety 
and with some ground for the belief that a degree of 
protection, however slight it may be, will be obtained. 

The Periodical Health Examination 

Altho, strictly speaking, any step that is taken for 
the detection of ill-health cannot be reckoned as a truly 
preventive measure as applied to the individual case, 
nevertheless, the periodic health examination is an ex- 
tremely powerful weapon in the control of tuberculosis. 

There is no doubt that, if generally adopted, the plan 
of putting ourselves into the hands of capable physicians 
once or twice yearly for a thorough going over from tip 
to toe, would lead to the recognition of many unsuspected 
cases of tuberculosis. This procedure is now receiving 
widespread commendation; and in both the interest of 
their policy holders and themselves, it is being advocated 
by many insurance companies, who appreciate that it is 
one of the strongest policies that one can take out. Isn't 
it just as easy to do this as it is to have one's teeth 
examined at regular intervals ? Those who are conscious 
that there is something holding them down, keeping them 
always behind in the swirl of life and affairs, may by 
periodically taking this simple precaution, start the 



HOW TO PREVENT TUBERCULOSIS 81 

wheels moving that will permanently remove the handi- 
cap. Why not make systematic examination of the whole 
body now and then a habit, and thereby mayhap save 
to one's self years of usefulness? 



LESSON IV 

IP THE CHEST HAD A WINDOW 

If one could look into the body affected with tuber- 
culosis, one would obtain a clearer insight into its nature, 
which would make it easier to interpret the signs that 
lead to its detection, and to grapple with the problem of 
retrieving health. With this idea in mind, the following 
paragraphs have been written in an effort to describe 
in non-technical language the structural alterations pro- 
duced by tuberculosis of the lungs. 

How Different from the Healthy Lungs! 

Were it thus possible to glance into the chest of the 
sufferer from tuberculosis, the picture would be quite 
different from the view gained on looking into the body 
of a well person. Instead of seeing, as in health, two 
delicate, light and spongy, gray or pinkish lungs, swing- 
ing easily and freely, and expanding and contracting 
evenly, as each breath is taken, the breathing organs now 
seen have an entirely different aspect. The top part, 
or perhaps some other part of one or both lungs, is seen 
to have changed into a rather solid and more or less 
soggy mass of a general darkish color; which, if picked 
up and compressed, no longer gives an airy and cotton- 
like feel to the touch. On the contrary, the affected 
portion is decidedly hard and almost solid, much like 
liver in consistency — a condition which long ago gave 
rise to the old term "consolidation of the lungs' ' as a 
synonym for tuberculosis. 

82 



IF THE CHEST HAD A WINDOW 83 

Evidences and Results of Nature's Handiwork for 
Repair and Compensation. The affected areas of the 
lungs, and in some cases other parts of these organs, are 
perhaps found to be covered with a thick, dense layer 
of tissue (thickened pleura). Then, too, in places the 
lungs are seen to be united to the chest wall by either 
delicate or firm bands, likewise formed of new tissue 
(pleural adhesions) which hold the diseased portions 
almost stationary, so that they barely move at all. Odd 
as it may seem, these incrustations or thickenings, and 
adhesions, are, in some degree at least, manifestations of 
Nature's efforts to prevent the spread of the disease and 
to repair past damage. Being bound down and pro- 
hibited to a greater or less degree from functioning, the 
disease areas are given rest and a better chance for 
healing. 

Here and there certain neighboring parte of the lungs 
unaffected by the disease are seen to have become stiff, 
and, for the present at any rate, functionally useless. 
(This is due to the cutting off of the air supply by dis- 
ease, scars, and the like.) On the other hand, still other 
nearby sections of the lungs, especially those a little 
more distant from the focus of disease, are rather en- 
larged and overdistended with air, as if Nature were 
trying to compensate for the "putting out of business' ' 
of one part of her air laboratory by having the other 
parts do extra duty. 

Effect on Other Organs. On looking further it is 
discovered that the damage has not been confined to the 
lungs alone ; for it is seen that in one way or another, 
the functioning of nearby organs has also been interfered 
with. For example, one notices some peculiar effects re- 
sulting from the subsequent contractions of the pleural 
incrustations and bands just described, and to the 
shrinking of scars formed in the lungs as a result of 



84 LESSONS ON TUBERCULOSIS 

iealing, as well as to the crowding effect of the enlarge- 
ment of the healthier air cells from taking on increased 
duty. Thus the large blood vessels that enter and emerge 
from the lungs and heart may be bent and distorted; 
and the heart, itself perhaps soft and flabby, may be 
cramped, and even pulled or shoved quite out of its 
ordinary position. On the whole, the normal rela- 
tionship of the chest organs may be considerably dis- 
arranged. 

A " Close-up* ' View. If one of the solid areas in the 
lung is inspected still more closely, it is observed that 
the surface is punctuated by a number of dots or islands 
of pearly white — little globular lumps or nodules, pro- 
jecting slightly above the surface, which vary in size 
from a pin head to a marble. Each nodule represents a 
colony of the germs of tuberculosis surrounded and 
ledged in by a wall of Nature's protective cells 
assembled at the spot to combat the germs. These lumps 
have been named tubercles, a term that has come down 
through the centuries, and which is said to have orig- 
inated from the likeness these small masses bear to an 
ancient unit of measure or weight. 

If a cut be made into the lung, similar dots or masses 
of white are found scattered throughout the substance of 
the organ, while between the tubercles the tissue is rather 
red and swollen, as in an ordinary inflammation. 

Similarity Between Tubercles and Boils. If the de- 
velopment and evolution of a number of tubercles could 
be followed throughout their complete course, there 
would be seen a rather striking resemblance between this 
process and the " ripening' ' and subsequent discharge of 
the " cores" of a group of boils. In this comparison, 
however, one outstanding point of difference would be 
noticed : the transitions undergone by the tubercles take 
place much more gradually. 



IF THE CHEST HAD A WINDOW 85 

Thus it comes about that as the disease progresses the 
tubercles grow larger and larger until, after a time, 
some of them begin to soften. This process usually com- 
mences in the center of the nodules, but often extends 
outward until the entire mass has taken on a decidedly 
mushy or cheesy character. By extension the softening 
process may also include some of the healthier lung tis- 
sue beyond the limitations of the tubercle proper. 
Sooner or later, individual tubercles unite, forming 
masses the size of peas, marbles or larger. Meanwhile the 
breaking down or softening of the tubercles continues, 
until in time the pulpy, cheesy masses in turn change 
to a thick liquid. 

As a rule, the softening process eventually opens a way 
into a bronchial tube (or the tubercles may have 
originally developed in the walls of the smaller bronchial 
tubes and in their growth subsequently have invaded the 
lung) ; whereupon the semiliquid material is coughed up 
and discharged as sputum. This breaking down process 
may through periodic extension involve quite a large area, 
so that when the centers of the neighboring masses are 
completely evacuated, only very thin walled partitions 
separate the holes in the lung — called cavities — that re- 
main, one from the other. It is probable that these inter- 
vening walls will sooner or later give way, when the 
individual cavities combine to form one, in this manner 
finally producing quite a large excavation. 

What Is Meant by "Open" Tuberculosis and 
11 Closed' ' Tuberculosis? Before proceeding further, 
it seems advisable to call attention to the fact that not 
all tubercles go on to the stage of softening. Under 
certain circumstances tubercles may be present in the 
lungs, yet may not for a long time, perhaps never, 
" ripen.' ' Again, even tho softening has taken place, 
the destructive process may fail to open a passageway 



86 LESSONS ON TUBERCULOSIS 

into a bronchial tube. In both of these cases, as no outlet 
is given to the discharge, the condition is spoken of as 
"closed" tuberculosis. In some instances, the disease 
always remains of this type. The point of importance 
in this connection is that persons suffering from 
"closed" tuberculosis cannot give the disease to 
others. 

On the other hand, if the destructive process has 
broken through into a bronchial tube, because an avenue 
has thus been provided for the discharge of the poison- 
ous matter from the body, this is in one way favorable 
to the future health of the individual. However, such 
a patient, unless careful in the disposal of his sputum, 
becomes a distinct menace to those near him. 

So, too, it may readily be seen that when the disease 
is still of the "closed" type, the poison pent up in the 
lungs may produce serious results ; yet it may be quite 
difficult for even the most expert physician to recognize 
the real cause of the illness. For of course, in such 
cases, the germs cannot be found in the sputum, altho 
they may be numerous indeed within the lungs. 

How the Tubercle Appears Under the Microscope 

Tubercle Comprises Nature's Fighting Cells Hem- 
ming in the Germs. If one of the small, firm, more or 
less spherical tubercles be examined under a high-pow- 
ered lens, it is seen to consist of a nest of cells, in and be- 
tween which the germs of tuberculosis are found in 
greater or less number. The cells composing the tubercle 
are of two main varieties : (1) Especially near the center 
of the nodule, are amassed a considerable number of large 
irregular-shaped cells, which have apparently originated 
from the stationary or fixed cells of the neighborhood by 
a process of rapid multiplication. (2) Intermixed with 
the cells just described, but found even in larger num- 



IF THE CHEST HAD A WINDOW 87 

bers near the periphery of the tubercle, are many small 
round cells very similar to, if not identical with, certain 
varieties of the white corpuscles of the blood (lympho- 
cytes). The point of interest in connection with these 
cells of various kinds is that they are all a part of Na- 
ture's army of fighters — the soldiers of the body — which 
have either been manufactured on the spot or assembled 
at the danger point and pitted against the invading army 
of germs. Here they may succeed in destroying the 
germs ; or at any rate will probably be able to hold the 
invaders in check temporarily. 

Subsequent Course of the Tubercle. If the defenses 
prove adequate, the tubercle may not progress beyond 
the minute, firm, pearly stage. Thus, in time, the germs 
are killed or eliminated ; Nature then removes her army 
of cells, so that very little, if any, effects of the invasion 
remain. Such a clean-cut victory is obtained only when 
the tubercles are very small. 

On the other hand, if the enemy army acquires con- 
trol of the situation, many of Nature's soldier cells are 
killed by poisons set free from the germs. At the same 
time, these concentrated poisons seep out into the sur- 
rounding healthier tissues, injuring or destroying the 
delicate fabric of the lung and preparing the way for 
further advance of the disease. 

In still other instances, though Nature's forces prove 
unequal to the task of completely routing the germs, 
the germs likewise fail to gain a decisive victory over 
the protective forces of the body. In such cases a truce 
is declared, and the tubercles may remain for months 
or years with no material change — latent tuberculosis. 
During this period of dormancy, the afflicted person 
experiences little or no ill effect. None the less, the 
presence of latent tuberculosis is a distinct threat to 
health and safety, because at any time some circum- 



88 LESSONS ON TUBERCULOSIS 

stance may intervene that will strike flame to the 
smoldering fire. 

" Mixed Infection" 

By the time that softening of the tubercles has taken 
place, and in some cases earlier or even from the outset, 
other germs than the tubercle bacilli have usually found 
their way into the air passages and, finding within the 
lungs a receptive soil, have joined the tubercle bacilli in 
a combined battle against Nature. This association of 
several varieties of germs — or the engrafting of one dis- 
ease upon another — is spoken of as a " mixed infection." 
In the olden days, when as a rule tuberculosis was not 
recognized until marked wasting of the tissues of the 
body had occurred, mixed infection had practically 
always already taken place. Let it be understood, then, 
that once the disease has progressed to the stage when 
the term "consumption" can be literally applied, a 
mixed infection is virtually always present. Among the 
germs commonly found in mixed infection are those 
which ordinarily produce pneumonia and boils, as well 
as others that are closely akin to the germs of erysipelas ; 
those that apparently play a part in the production of 
la grippe (influenza) ; and those that in the ordinary 
course of events are responsible for "colds." 

Kindred Diseases 

In certain occasional instances, some of the germs just 
listed or still others gain entrance to the breathing pas- 
sages, unaccompanied by and without the previous pres- 
ence of the germs of tuberculosis. Yet these other germs 
bring about a chronic inflammation or consolidation of 
the lungs similar to that caused by the tubercle bacilli. 
Included in this group of germs producing diseased 
conditions closely resembling genuine tuberculosis, in 





HOW TUBERCULOSIS BEGINS 

Above, diagrammatic view of normal lungs. In lower drawing the 
small rounded masses represent tubercles, while between the tubercles 
the tissue is inflamed and hardened to a liver-like consistency. In the 
left lung some of the tubercles have softened and been expectorated, 
leaving a cavity. 



IF THE CHEST HAD A WINDOW 89 

addition to those above mentioned, are (less commonly) : 
those organisms that ordinarily produce " lumpy jaw" 
(actinomycosis) in cattle (and also a group of closely 
related germs — one of which is called streptothrix), the 
germs of syphilis, and a related germ sometimes called 
Castellini's spirochete. 

It is well for it to be realized that in each of these 
allied ailments not only the picture of disease in the lung 
closely imitates tuberculosis, but the outward evidence 
of these various ills — that is to say, their symptoms — are 
also not rarely with difficulty distinguished from those 
produced by real tuberculosis, 

A Troublesome Question Answered. Patients some- 
times feel much concern if any doubt exists as to whether 
their illness is caused by pure tuberculosis, or whether 
it is due to a mixed infection. Likewise, since there is 
the possibility that the sickness may be caused solely by 
one or more of the allied diseases simulating tuberculosis, 
the afflicted person is sometimes quite unsettled as to 
whether or not he is getting the proper treatment. He 
may also have doubt as to whether continued adherence 
to the program that has been mapped out for him is 
necessary. Here, then, let it be pointed out that these 
various diseases, including (1) unadulterated tubercu- 
losis, (2) mixed infection, and (3) the chronic lung condi- 
tions caused wholly by one or more varieties of germs 
other than the tubercle bacilli, are all serious. All 
may terminate in "consumption"; that is to say, in 
marked loss of flesh, and death. All, in the present state 
of medical knowledge, require essentially the same gen- 
eral, or natural, methods of treatment or management. 
At any time a remedy with a strong curative action 
against the tubercle bacillus alone, or against one or 
several of the other germs alone, may be brought forth, 
but until such a remedy actually comes to the fore 



90 LESSONS ON TUBERCULOSIS 

it does not make a great deal of difference which germ or 
germs must shoulder the blame in the particular case.* 
Scientific Accuracy versus Practical Efficiency. In 
all cases, for the sake of scientific accuracy and also to 
the end that no measure offering even small opportunity 
of benefit to his patient may be neglected, the physician 
will make every effort to separate the conditions, and to 
bring to light the exact germ or germs responsible in 
the given case. But if in spite of his best efforts the 
physician fails in this endeavor (as sometimes even the 
most expert physician will fail), no alarm need be felt. 
When in doubt, the only safe rule is to regard the 
condition as tuberculosis until proved otherwise, and 
to apply with vigor and persistence the measures 
known to be useful in this disease. 

"Miners' Consumption" 

That peculiar ailment known as "Miners' Consump- 
tion" is another rather intimately related and interest- 
ing condition accompanied by hardening or solidifying 
of the lungs. In this disease the continual irritation set 
up through the breathing in of foreign particles of stone, 
coal, ore or the like, in the form of fine dust, results in 
the gradual development of extensive areas of inflamma- 
tion within the lungs — a process that terminates in a 
widespread overgrowth of scar tissue throughout these 
organs, which gives rise to symptoms almost identical 
with those caused by the tubercle bacilli. In respect to 
this malady the most significant feature is that the dis- 

* However, it is especially important that syphilis of the lung, 
or actinomycosis or related diseases be recognized, as specific 
remedies of value have long been at hand for these conditions. 
This is especially true as regards syphilis, which, however, at- 
tacks the lungs but rarely. Fortunately, too, actinomycosis 
seldom occurs in man. Vaccines and sera are now being em- 
ployed against many of the germs frequently present in mixed 
or allied infections, with some benefit. Nevertheless, the chief 
curative treatment of all of these ailments, when chronic and 
resembling tuberculosis, coincides in all important particulars 
with the treatment or management of pure, or genuine, tuber- 
culosis. 



IF THE CHEST HAD A WINDOW 91 

ease is not caused by a germ. Hence, pure " Miners' 
Consumption" offers no danger to other persons. It is 
true, however, that in some instances the germs of tuber- 
culosis later find lodgment in the inflamed tissues; in 
this event, actual tuberculosis may develop. On the 
other hand, some observers believe that "Miners' Con- 
sumption' ' in some manner provides the body with a 
certain amount of protection — which is, to be sure, in- 
complete — against true tuberculosis. 

Manner in Which Tuberculosis Impairs Health 

As previously indicated, the tubercles have a prejudi- 
cial effect on health in a number of ways, which will now 
be summed up and noted a little more carefully. 

1. the effect of poisons seeping out from the focus 

of disease 

How the Poisons Originate in Three Ways. During 
the course of tuberculosis, especially when the disease 
is extending rather rapidly, poisons are constantly escap- 
ing into the blood stream, whence they are distributed 
widely throughout the body. To a greater or less ex- 
tent, then, every organ and part is made to feel the 
influence of the disease. 

These poisons take their origin from at least three dif- 
ferent sources: (a) They are set free from the tubercle 
germs, (b) They are set free from other germs — the 
germs of mixed infection (just described), (c) They 
are produced as a result of the death and decay of the 
cells composing the tubercle and the surrounding tissue — 
a destruction that takes place just to the extent that 
the germs overmaster Nature's defense. 

Fever Indicates Nature Is Fighting: How One Some- 
times Grows Worse in Order to Get Better. In regard 
to the poisons derived from the tubercle germs, it 



92 LESSONS ON TUBERCULOSIS 

may be recorded that, paradoxical as it may seem, 
these poisons are only in small amount cast off from 
the germs so long as they are alive. (To a limited de- 
gree this is also true of the poisons taking their source 
from the other germs mentioned.) It is only as the 
bodies of the dead germs disintegrate, that the poisons 
are liberated in large quantity. In other words, the set- 
ting free of poisonous material from the decaying bodies 
of the germs often has a tendency to cause the patient 
to seem worse at the very time that he is — in a way — 
really taking a step toward recovery. 

From this it is learned that the little rises in fever 
prone to occur during the disease should not be taken 
too seriously. To be sure, every practicable measure for 
giving the patient additional support while passing 
through the little stormy period should be employed. 
But merely because for a few days, a few weeks, or even 
longer, the fever is a little higher, it need not be felt that 
one is necessarily on a downward course. As a matter of 
fact, the defensive forces of the body may have just 
succeeded in putting a goodly number of the germs "out 
of the running";* when the effect of this fresh dose of 
poison has spent itself, the fever and associated ill f eel- 

* This, of course, implies that the body has been called upon 
to put up a more vigorous fight. (Hence the importance of con- 
serving the energy so that Nature may be "backed up" in every 
way possible at this time. This means Rest, spelled with a 
capital R.) Doubtless some may wonder whether the necessity 
for putting up a harder fight has not come about in turn solely 
because the germs had already begun to multiply more rapidly. 
"If this is true/' such a patient may argue, "even tho fever 
is an indication that the germs are being killed, am I really 
the gainer?" Here is the answer: In some cases it is a fact that 
the sequence of events is exactly as this patient surmised. 
Whether or not in such a case the sufferer will actually benefit in 
the end, depends on just how strong the fight the defensive 
forces of the body wage — just how much they are stimulated in 
their struggle with the germs. 

In other cases, however, repeated studies have shown that, 
oddly enough, Nature is inclined to make periodical spurts in 
her endeavor to overcome the germ invaders, irrespective of 
whether or not she has been incited to more vigorous efforts by 
renewed onslaughts of her microscopic enemies. In many such 
instances the net result of each of these up-waves in the fever 
(and perhaps other symptoms) is a step forward in the healing 
process. 



IF THE CHEST HAD A WINDOW 93 

ings will subside. With some of the germs thus forever 
eliminated from the combat, as soon as the defensive 
forces have had time to recoup their losses, strength and 
cheer will probably be regained. Once having success- 
fully weathered the little storm, the invalid is often fairly 
surprised to find himself just so much nearer the goal ; 
and so sees there is good reason for increased hope and 
encouragement. 

2. WIDESPREAD RESULTS BROUGHT ABOUT THROUGH THE 
BODY'S TELEGRAPH SYSTEM 

It may be surmised that as the disease advances, the 
sensitive nerve fibers within the reach of the destructive 
process will be destroyed or seriously injured, giving rise 
to pain and to interference with the function of the 
lungs. More surprising, however, is the fact that mis- 
leading disturbances of organs quite distant from the 
focus of infection are often brought about via the body's 
telegraph wires — the nervous system. 

How the Nervous System Controls the Body's 
Workshop. Here it may be well to recall that the 
nervous system consists of an intricate arrangement of 
nerves radiating out from the brain and spinal cord, with 
terminals reaching every organ and recess of the body. 
By means of these interlacing telegraph wires the move- 
ments of each muscle and part are controlled, and the 
action of the various organs regulated in a harmonious 
manner in accordance with the needs of the body as a 
whole. In response to messages coming in to the cen- 
tralized points of control — the brain and spinal cord — 
orders are instantly flashed out, directing a certain organ 
to " speed up," or, as the case may be, to "ease down," 
a little in its work. 

The Lungs Merely One Terminal on a "Party Line." 
If it is remembered that one of the most important nerves 



94 LESSONS ON TUBERCULOSIS 

of the lungs (called the vagus nerve) also sends branches 
to many other organs, including the throat, the voice box, 
the heart, the stomach and intestines, the liver, the ear, 
etc. ; and if it is further recalled that this nerve of many 
branches is but a single link in the immense network of 
nerves with antennae reaching to the body's innermost 
niches, one will perceive how easy it is for messages of 
distress originating in the lungs to go astray and (like 
the miscarrying of messages over a telephone system 
when the "wires are crossed") give the impression that 
the call for aid or relief came from other, perhaps distant 
regions of the body. So, too, it is readily seen how, in 
response to these urgent signals, entirely misdirected 
despatches may occasionally be sent out from the brain 
or spinal cord — despatches which likewise go far wide 
of their proper destination, causing organs for which 
they were not intended to slow down or speed up in work. 

An Odd State of Affairs with Both Good and Bad 
Features. Here it is necessary to pause a minute, 
while a word of explanation is given. Strange to relate, 
the lung substance is one of the few portions of the body 
almost entirely unequipped with nerves capable of con- 
veying painful sensations. On the other hand, the pleura 
(the lining covering the surface of the lungs and the 
inner surface of the chest wall) is richly supplied with 
many highly sensitive nerve filaments. Whether this odd 
arrangement is due to an oversight on Nature's part, 
or whether it is an evidence of her foresight and wis- 
dom, with the intention of avoiding trouble, is yet in 
doubt. Be that as it may, the comparative scarcity 
of such nerves in the lungs has been as a soothing balm 
to many a sufferer, and on the other hand has some- 
times worked greatly to his disadvantage. 

The well known observation that persons afflicted with 
tuberculosis seldom suffer from severe pain in the lungs is 



IF THE CHEST HAD A WINDOW 95 

thus accounted for. Thus far, the scanty supply of 
sensory nerves may be regarded as a blessing indeed. 
Unfortunately, however, this relative freedom from pain 
which, if it had been present, or had been a more prom- 
inent feature, would have served to direct the invalid's 
attention to his illness at a much earlier period, has been 
the explanation of many a tardy diagnosis. 

How Pain Is Often Referred to the Surface of the 
Lungs. It goes without saying that the foregoing 
statements are not meant to give the impression that 
pain never occurs in tuberculosis. Rather, they are in- 
tended merely to indicate that when pain is present it 
is usually of a moderate character, and that it is often 
referred to the surface of the lung or elsewhere (reflex, 
referred, or sympathetic pain). By way of illustration, 
it may be explained that pain is often absent or of quite 
mild character until the disease approaches that portion 
of the lung just beneath the pleural covering. On the 
contrary, now and then a case occurs in which from the 
outset a superficial area of the lung has been affected, so 
pain has been more marked from the very first. In both 
of these instances pain may be an outstanding feature, 
and in fact, a small focus of disease near the pleura may 
cause an amount of pain quite disproportionate to the 
size of the area involved. 

Healing Pains. In other cases, contradictory as it 
may sound, pain is negligible or entirely absent until 
the patient is well on the mend. Thus, even tho early 
in the disease a large section of the lung may have been 
destroyed, there may have been little pain because few 
nerves adapted to the conduction of messages of pain 
were injured. Later, after healing has begun and as 
the newly formed healing tissue becomes set into firm 
scars, which gradually shrink and harden more and 
more — the few nerve fibers within the grasp of these 



96 LESSONS ON TUBEECULOSIS 

scars are sharply pinched, so even these relatively- 
lethargic fibers are awakened into a comparatively acute 
outcry of pain. 

Moreover, as the scars become smaller they exert a 
pulling effect on the neighboring tissue and indirectly 
make traction on, and dimple-in, the surface of the lung. 
Thus, through drawing on the intervening tissue, the 
more sensitive nerve filaments located in the pleura and 
at other places fairly distant from the actual seat of 
trouble, are irritated. As a result, the strange phe- 
nomena of peculiar drawing sensations and healing pains 
are brought about. 

Shoulder and Arm Pains. Delving a little deeper, 
we recall that under ordinary circumstances we are 
wholly unaware that the chest is a busy workshop, and 
go our daily ways entirely unconscious of sensation of 
any kind within us. Now, if it be remembered that dur- 
ing tuberculosis wholly new impulses are initiated within 
the chest, we see how easy it is for the great central con- 
trolling telegraph station of the body (the brain and 
spinal cord) to erroneously assume that these new mes- 
sages come from one of the more ordinary sending sta- 
tions. That is to say — from a part of the body from 
which the patient has been accustomed to receiving pain- 
ful impressions ; which ordinarily means from some su- 
perficial area. As a matter of fact, the chance of the 
sidetracking of the messages is made even greater by 
the peculiar anatomical linking up of certain superficial 
nerves of the body with those supplying the lungs. In 
this connection, the significant item is that the nerves 
distributing to the lungs branch off from the main nerve 
trunks near the point where the nerves that supply the 
skin and muscles of the chest, shoulders, neck and arms, 
take their origin. 

This odd arrangement of the body's telegraph wires 



IF THE CHEST HAD A WINDOW 97 

is, then, the explanation of a large number of the divers 
aches and indefinite pains occurring in the course of tu- 
berculosis. For example, the tired feelings, which some- 
times amount to actual pain or aches, usually of a mild 
character, over the chest, in the shoulders, neck and 
arms, which are fairly common in tuberculosis, and are 
often mistakenly ascribed to rheumatism, to catching cold 
or to some other like influence, are in many instances 
really brought about in this manner. 

It is but natural to assume that as a result of the dis- 
ease within the chest, actual inflammation would occa- 
sionally be set up in some nearby nerve. It may further 
be surmised that the inflammation would tend to extend 
along the nerve toward, and perhaps clear to, its origin 
from the parent nerve trunk. One would also suppose 
that if the inflammation continued to spread along the 
nerve trunk, as it came to the point where the nerves 
running to the exterior parts of the body branch off, 
these likewise would become inflamed. In very truth, 
this is not rarely the case ; and the inflammation of the 
superficial nerves (neuritis) thus produced, furnishes 
yet another explanation of some of the perplexing pains 
in the arm, the neck and other parts, which are sometimes 
a prominent feature of tuberculosis, either during its 
course or as healing sets in. 

Influence of Weather on Pain. Persons suffering 
from tuberculosis often state that on certain days they 
feel pain more keenly than at other times. Likewise, 
physicians who have a large number of patients under 
their care frequently notice that when the weather under- 
goes a change, a great many of their patients have their 
attention directed to pain for the first time, or complain 
that former pains are exaggerated during this period. 
Furthermore, persons who have previously sustained in- 
jury elsewhere on the body not rarely remark that long- 



98 LESSONS ON TUBERCULOSIS 

standing scars are apt to become more tender and 
sensitive on such days. 

Nor is it by any means always the cold and damp 
days on which groups of patients thus bear one another 
company in distress. At one time, for example, the 
weather is cold and damp, yet at another (though less 
commonly) it is hot and dry. Evidently there is some 
unrecognized influence at work, but whatever the exact 
atmospheric change responsible, it can readily be seen 
how the alteration of the blood supply to the diseased 
areas or to long-forgotten wounds and scars may cause 
congestion and swelling, which in turn lead to pressure 
upon the nerves, thereby calling attention to the old 
trouble once more. 

3. MECHANICAL DISTURBANCES 

The mechanical disturbances occasioned by the contrac- 
tion of the scars in the lungs and by the encroachment of 
the relatively sound portions of these organs, as they 
enlarge, all tend to cause a displacement of the neighbor- 
ing organs and to hinder them in the performance of 
their duties. This is especially true of the heart. 

4. INTERFERENCE WITH THE HEART MEANS GENERAL 
BODILY INEFFICIENCY 

As each of these influences (numbered 1, 2, and 3) 
affect the heart to a greater or less degree, in turn inter- 
fering with the supplying of nutriment to, and carrying 
away of impurities from, each bodily cell, it is evident 
that here is yet another way whereby deceptive derange- 
ments of other organs may be produced. 

This list of the various routes and means by which 
false clues may be produced, might be extended still 
more, but these will suffice to make clear that it is neces- 
sary for one who is suffering from disturbances that may 
by any possibility be due to tuberculosis, to be sharply on 
his guard. 



LESSON V 

HOW TUBERCULOSIS MAY BE RECOGNIZED 

This lesson is an effort to keep the reader on guard 
against tuberculosis and to point out the chief signs and 
means by which tuberculosis may be detected, so that 
the suspicions may be aroused in time and a physician 
skilled in dealing with tuberculosis consulted promptly. 

Preconceived Ideas Should Be Laid Aside. Almost 
everyone recognizes the death-like pallor, the sunken and 
perhaps flushed cheeks, the pinched features and the 
haggard expression, of the victim of advanced tuber- 
culosis, who slowly drags his wasted form about, his 
course now and then checked by a spasm of coughing 
which racks his frail body and causes his face to distort 
with pain. Altho it is often possible for one to put up 
a winning fight even after the disease has progressed 
thus far — to the stage of consumption — it is necessary 
for one to lay aside this picture as representing early or 
moderately advanced tuberculosis — the stage in which 
the disease should be recognized if the sufferer is to be 
given his due chance for victory. The fact should be 
impressed on the mind that far from seeming seriously 
ill, the person afflicted with early tuberculosis usually 
appears entirely well.* (Case No. 5, later in this lesson, 
will serve fairly well to illustrate this point.) 

What Cases of Tuberculosis Require Recognition and 

* Conversely, an individual will now and then be met who has 
all the outward appearances of advanced tuberculosis, yet who 
really is entirely free of this trouble, and in fact is suffering 
from some wholly different ailment. This merely furnishes addi- 
tional proof of the truth of the time-worn saying that appear- 
ances are deceitful. 

99 



100 LESSONS ON TUBERCULOSIS 

Treatment? When considering the means for recog- 
nizing tuberculosis, there comes to mind the question : 
Is a mere trace of tuberculosis a sufficiently serious 
menace to necessitate treatment? The answer is: 
-4s a rule, No; because a trace of tuberculosis has no ma- 
terial effect on health and because the process will in the 
majority of cases advance no further. Careful investiga- 
tions have disclosed the fact that in civilized countries 
approximately seventy-five per cent of the children have 
acquired in some part of the body at least a trace of tu- 
berculous infection by the time they have reached the 
age of fifteen ; and that roughly ninety per cent of civi- 
lized persons harbor at least a slight infection during 
some part of the life span. When a safe and easily ad- 
ministered remedy, effective in a few doses, is produced, 
it will be advisable to apply the treatment generally ; but 
with present methods active treatment of everyone who 
is only "a little bit tuberculous" is neither feasible nor 
necessary. 

The presence of a trace of tuberculosis can be detected 
only by the expert physician. When this condition is 
discovered, it is perhaps well for the individual to be 
informed of the fact. Or, what is more important, if 
detected in childhood, the condition should be explained 
to the parents in order that they may shield the child 
from undue strain and keep on the watch for any evi- 
dence pointing to an advance of the trouble. In these 
instances the protective measures described in Lesson 
III may be applied. Only exceptionally is definite treat- 
ment called for in this group of cases. 

When Symptoms Are Produced Treatment of Tuber- 
culosis Is Imperative. The further question arises? 
What cases of tuberculosis require treatment? When- 
ever the well-being of the individual is influenced in any 
manner — that is, when symptoms occur — treatment is 



HOW TO RECOGNIZE TUBERCULOSIS 101 

definitely called for ; if the symptoms have recently be- 
come more noticeable, the urgency is greater.* Ex- 
perience has demonstrated time and again that when 
the infection has developed to this degree, that is to say, 
when it has resulted in disease, as ordinarily understood 
(evident or clinical tuberculosis), the condition is always 
serious ; and if allowed to drift along without being com- 
bated, will, in by far the greater number of cases, sooner 
or later continue to progress. If the disease is limited in 
extent, and has caused only a few symptoms, it is spoken 
of as incipient or first-stage tuberculosis (the mere trace 
of infection not being considered) ; and it should be 
understood that incipient clinical tuberculosis is 
always a serious matter. 

In addition to those cases that show symptoms, treat- 
ment is sometimes required for other reasons. For 
example, now and then a case occurs in which, although 
outward evidences (symptoms) are lacking, a large area 
of disease is present. These cases also demand treatment, 
but as they embrace only a small group, and can be 
recognized only by the expert, they need not be further 
considered here. 

Hereafter, in these lessons, unless specifically stated 
otherwise, all references to tuberculosis are to be under- 
stood as pertaining to real or manifest tuberculous dis- 
ease (clinical tuberculosis) ; not to a mere trace of in- 
fection. 

How the Disease Begins 

Tuberculosis has a very variable and irregular course, 
and its first noticeable effects vary widely in different 
cases. There is, however, one feature that is associated 
with nearly all cases — the slowness of its onset. The evi- 

* By the term symptoms is meant any indication, of whatever 
nature, that something is wrong with the well-being-. It goes 
without saying that the individual, himself, may be entirely 
unaware of the true significance of the symptoms. 



102 LESSONS ON TUBERCULOSIS 

dences of the disease appear very, very gradually — much 
more gradually even than is ordinarily supposed. There 
are of course a few cases in which the disease breaks 
upon one rapidly indeed (see " Galloping Consumption," 
later in this lesson) ; but in the great majority of in- 
stances it creeps in so slowly and its few manifestations 
are added so infrequently, that quite commonly the in- 
dividual entirely fails to heed them. He may incline 
toward the belief that he has always suffered in the same 
way, or may consider that the little disturbances he has 
noted are merely the normal experiences of everyone as 
he grows older. Again, he may attribute them to some 
trivial or entirely unrelated matter. It is often necessary 
to look back over a long period-— often several years — in 
order to see that he is no longer enjoying free-and-easy 
and unlimited health. 

The Significance of Tuberculosis in the Family 

The bare history of tuberculosis in one's ancestry, bn 
which much stress was formerly laid, is now given less 
weight as an aid to the recognition of the disease. The 
fact that one's distant relatives have suffered from the 
disease is practically of no moment. When, however, the 
immediate relatives (for example, the parents, grand- 
parents, or brothers or sisters) have been tuberculous, the 
matter assumes greater importance. Even so, such an 
occurrence bears really pointed significance only if the 
Illness of the relative occurred at such a time that the 
suspect was intimately associated with the sick person 
over a long period. If such association occurred during 
childhood the child is almost sure to have become in- 
fected, and the probability is large in this case that the 
infection gained deep foothold and will develop sooner 
or later into evident or manifest tuberculous disease. 
The absence of tuberculosis in the family has no bear- 
ing of importance. 



HOW TO RECOGNIZE TUBERCULOSIS 103 

Pointers in the Personal History 

Dangers of Intimate Association, Even Years Pre- 
viously, If one has been closely associated with a 
victim of the disease (who suffered from "open" tuber- 
culosis, see Lesson IV) this often furnishes a very 
valuable clue to the nature of the present ailment. It 
should be remembered that exposure many years pre- 
viously may be the cause of the present outbreak. (As a 
matter of fact, infection usually takes place during child- 
hood — as described in Lesson II.) 

Retarded Convalescence from Certain Diseases. The 
history of "kernels" in the neck, or sometimes in other 
parts — "scrofula" (which often means tuberculosis of 
the lymph glands) — in childhood, is important; as is 
also the history of unusually slow convalescence from 
other diseases. Retarded recovery from measles or 
whooping cough is especially suggestive; the more so, 
if followed by a protracted cough, or if one has not been 
strong since the attack. Many of the cases of so-called 
unresolved pneumonia or chronic "grip" are actually 
tuberculosis. 

There Is Always a Reason. Many individuals who 
have always been delicate or to whom the term "weak 
constitution" applies, are really suffering from tuber- 
culosis. If you are one of those who say : "I have never 
been strong," or "I cannot remember when I had a well 
day," or "I have not been really up to par for years," 
remember that there is a reason — and the reason may be 
tuberculosis. If, in addition, you are under weight and 
have the long, flat type of chest, the suspicion grows 
stronger. (This type of chest, formerly looked upon 
mainly as predisposing to tuberculosis, is now considered 
in many cases to be a result rather than a cause.) 

Many a "puny" child owes his frailness to tuber- 



104 LESSONS ON TUBERCULOSIS 

culosis. Other children, who perhaps have adenoids or 
enlarged tonsils, who are almost constantly sick, who 
11 catch nearly every disease that comes along," may owe 
this general susceptibility to disease to the fact that they 
are already victims of this plague ; which in turn so low- 
ers their resistance that they fall a ready prey to many 
ills. Carefully conducted scientific study made in late 
years has shown that just as many a backward child of 
the South owes his "laziness" to the " hook-worm,' ' so 
many a delicate individual is, unknown to himself, labor- 
ing under a handicap — tuberculosis — a handicap which 
fortunately can usually be thrown off by the application 
of proper measures. 

Excessive Mental Concentration and Overwork May 
Precede the Breakdown. In some instances the out- 
break of the disease is preceded by intense physical or 
mental strain, or both, such as unusual business dif- 
ficulties, the care of a sick member of the family, or the 
like — which so sap the resisting power of the individual 
that, if in addition he is thrown into close contact with 
a person ill of tuberculosis before he has gotten back into 
condition, the disease is liable to secure a firm grip upon 
him. Or, as the case may be, a previously dormant focus 
of the disease (of the existence of which one may 
previously have been entirely in the dark) may at this 
time flare up and lead to a quite evident outbreak. 

Danger Signals 

In an earlier paragraph it was stated that those who 
wished to fortify themselves by acquiring a knowledge of 
the symptoms of tuberculosis, should at the outset en- 
deavor to free the mind of all preformed ideas on the 
subject. As they proceed, they will see that this is neces- 
sary because many things formerly considered fore- 
runners of tuberculosis (that is, paving the way for 



HOW TO RECOGNIZE TUBERCULOSIS 105 

its development) axe now known to be quite often 
evidences of tuberculosis itself. 

GEOUP "A" — SUGGESTIVE WARNINGS 

1. A Run-down Condition. The sufferer from tu- 
berculosis may first be made aware that something is 
wrong by the fact that he is noticeably ' 6 running down, ' ■ 
— by the realization that his customary vim is lacking, 
or that his ambition or zest for work is failing. An un- 
explainable languor comes on at times, and is quite likely 
to be attributed to laziness. Ordinarily feeling well 
and seemingly strong, yet he often finds himself suddenly 
growing tired. He seems to have plenty of strength, but 
lacks "staying power"; slight efforts, previously pleas- 
ant, have become irksome ; that which was formerly easy, 
now is a task — a drag. Yet, tho he plays out quickly, to 
his surprise a short rest may suffice to brace him so 
completely that he is led to think, "Oh, it is nothing. " 
Still, he has a vague sense of uneasiness ; an ill-defined 
feeling remains that all is not right. Quite commonly, 
associated with these changes, the victim notices that his 
appetite is failing, or that it is one day good, the next 
day poor ; or he may be troubled with other more definite 
disturbances of the stomach. As time passes, there may 
come to him who is passing through these experiences, 
the thought, "I'm young and should be enjoying my best 
years ; yet here I am — playing out ! What can be the 
matter with me?" 

Nerve Fag. In other cases, nerve fag may domi- 
nate the picture, or may be the earliest sign that the 
human clock is running down. Things that require con- 
siderable output of nervous energy, such as brain work, 
may tire one more than physical labor. The individual 
may find it hard to concentrate his attention upon 
the matter in hand, may lack decision, or may even lose 



106 LESSONS ON TUBERCULOSIS 

interest in things, developing an unwonted " don't care" 
attitude. He may notice that his disposition is changing, 
that he has become peevish, easily irritated and worried 
by small matters — that he has acquired a temper. Spells 
of despondency may occur. Restlessness may become 
prominent and sleepless nights frequent ; or on the other 
hand, it may be noticed that after a night of compara- 
tively sound sleep one does not feel refreshed as usual. 
These or other manifestations of ' 'nervousness" may in- 
fluence the sufferer or his physician to assign the run- 
down condition solely to a mere " nervous break-down." 
Many do not know that very early in tuberculosis one 
may be entirely free from cough, and that some of the 
symptoms just described (due in part to the effect of the 
poisons seeping out from the focus of disease on the 
nervous system and body as a whole) may be the only 
apparent evidence that something is amiss. It goes with- 
out saying that* symptoms of this nature are not always 
caused by tuberculosis, yet tuberculosis is one of the most 
common causes of a run-down condition and of "nervous 
breakdown." Unless, therefore, such symptoms are 
definitely traceable to overwork or other proven cause, 
and also if the manifestations are disproportionately se- 
vere, tuberculosis should be suspected. 

2. A Loss of Weight. A loss of flesh in some cases 
occurs early. Even a slight decrease in weight, if pro- 
gressive, or if associated with other symptoms, is im- 
portant, unless otherwise accounted for. 

3. Fever, Chills or Chilly Sensations and Sweating; 
Rapid Heart. If fever develops (and it should be 
understood that early in the disease fever is often ab- 
sent, and in fact in some cases is not detected throughout 
the complete course of the disease), it is apt to be low at 
first — often not more than a few tenths of a degree, and 
detectable only by a thermometer ; it is irregular in many 



HOW TO RECOGNIZE TUBERCULOSIS 107 

cases and may recur only in periodical waves, following 
an interval of several days or weeks during which the 
temperature is normal. When present, the rise may 
occur only at a particular time of the day, most likely 
in the afternoon or evening. Disagreeable chilly feel- 
ings or distinct chills may occur. Likewise, one who has 
not previously perspired easily may discover that now 
he sweats freely on the slightest provocation — at times 
merely as the result of a little excitement. Sweating 
under one or both arms, and sweating during sleep, are 
especially suggestive. 

Noticeable Beating of the Heart. Fluttering of, or 
rapid beating of the heart, which may be so forcible as 
to be perceptible to the individual, is ofttimes an early 
symptom. 

4. Shoulder and Chest Pains. Aching or painful 
sensations, usually of a dull character and moderate, in 
or near one or both shoulders, but which may extend to 
the arms or the neck, are fairly common accompaniments 
of disease in the chest. Too often, it is taken for granted 
that such pains are caused by rheumatism. Recurrent, 
wandering chest pain, one day in one part of the chest, 
the next day in another part; and pain which persists 
for some time in the same place— or "sore spots" on 
the chest — each and all are characteristic of tuber- 
culosis. 

GROUP "b" — MORE DEFINITE EVIDENCE 

1. Cough and Clearing of the Throat. When cough 
occurs early in tuberculosis it is usually dry — a mere 
hack — and is often erroneously attributed solely to the 
tickling sensation in the throat that precedes it. The 
cough may occur only after talking, after laughter, sing- 
ing or other exertion that tends to deepen the breath- 
ing ; again it may be produced only by excitement. In 



108 LESSONS ON TUBERCULOSIS 

other cases it may be noticed only in the morning, in 
which event it is likely to be ascribed entirely to the fact 
that one has just stepped out upon the cold floor ; or at 
night — in this case the blame is commonly laid purely 
to atmospheric changes. A tendency to clear the throat 
at short intervals is also of importance. Too frequently, 
without investigation, smoking or nervousness is assumed 
to be the root of these symptoms. 

Later, as the disease progresses, sputum will probably 
form, but is likely to be scant for some time, and in 
many cases is so easily raised — without cough — that one 
is convinced that it comes from the throat. In this 
case, the wave-like motion of the cilia (minute hair-like 
processes or lashes) that line the bronchial mucous mem- 
brane carries the sputum up into the throat, where it is 
first brought to the attention of the individual, and is 
then readily hawked out. It is unfortunately true that 
some persons, who have a " loose' 9 cough yet produce 
nothing, involuntarily swallow their sputum as soon as it 
reaches the throat. Make sure, therefore, you are not 
being misled into believing that you have no sputum, 
when perhaps in fact you are not only running the 
chance of doing yourself harm by swallowing it, but are 
unconsciously delaying the day when your ailment will 
be recognized so that you may start to rid yourself of it 
forever. 

2. Hoarseness, Loss of, or Weakening of the Voice. 
One or more of these, or other throat difficulties, in some 
cases usher in the disease. Fatigue of the voice, which 
may be evident only on reading aloud; or a slight 
huskiness, may give the first inkling that all is not well. 
When these symptoms occur early they are especially 
likely to be temporary and fleeting, but are often recur- 
rent. 

3. Frequent or Prolonged Colds and Catarrh. The 



HOW TO EECOGNIZE TUBERCULOSIS 109 

person who says, "Oh, I hardly get over one cold before 
I have another," may find right in this statement a 
valuable clue. Colds that are drawn out week after 
week, especially if frequently repeated, sometimes con- 
stitute the most conspicuous feature of either a straight 
out-and-out, or an underlying tuberculosis. This like- 
lihood is strengthened if one has formerly enjoyed a 
relative freedom from colds. If the colds are deep- 
seated — chest colds — weight is again added to the sus- 
picion; but colds beginning in the head are also im- 
portant. Those who are accustomed to winter colds, but 
who now find that the colds show a tendency to drag on 
into the spring, should be particularly watchful. Sum- 
mer colds having the characteristics just mentioned are 
also to be looked upon with perhaps special suspicion. 
Even a single cold that hangs on longer than a month 
should receive careful investigation. 

The above statements are not to be understood as im- 
plying that all, or even the majority of colds are due to 
tuberculosis; for as a matter of fact most colds are 
entirely distinct and separate affairs, having absolutely 
no relation to this disease. On the other. hand, it is 
equally true that colds of the type described are quite 
often in one or more ways, each standing partly as cause 
and partly as effect, closely bound up with tuberculosis. 

Colds May Not Be What They Seem. In the first 
place, many of the so-called colds, and many sup- 
posed attacks of la grippe, are not what they seem, 
but are actually waves in the course of tuberculosis — ■ 
characteristic flare-ups that are but the ordinary ac- 
companiments of this disease. In other cases, colds lower 
the resisting power of the body and render the soil fertile 
for the growth of the seeds of tuberculosis. Altho the 
person so afflicted is probably unaware of the fact, it is 
often the case that there has been present in the lungs 



110 LESSONS ON TUBERCULOSIS 

for some time a latent or slumbering area of tuberculosis. 
Each cold gives only too good an opportunity for the 
dormant disease to light up and make a little further 
headway. In still other cases the exactly opposite in- 
fluence prevails; in this case a preexistent tuberculosis 
furnishes the background — the suitable soil — upon which 
the colds develop. Thus it is seen not only that tu- 
berculosis favors the development of colds and that the 
colds in turn favor the extension of the tuberculosis/ 
but it is noted that tuberculosis itself often has 
periodical outbreaks closely resembling true colds. 

All in all, it is apparent that the periodical group of 
symptoms which some of us are accustomed to cast out of 
mind, with the words "It is only a cold," often has a 
deeper and more serious meaning. Whatever the rela- 
tionship that obtains in the given case, it is evident that 
beneath the mask tuberculosis is often hidden. 

In like manner, many persons suffering from supposed 
simple catarrh are really victims of tuberculosis. Let it 
be emphasized also that true bronchial catarrh (chronic 
bronchitis) seldom occurs before middle life. 

GROUP "C" — TELL-TALE SIGNS 

1. Pleurisy. Pleurisy may manifest itself as a 
stitch or knife-like stab-in-the-side, made worse by deep 
breathing or coughing. At other times the evidences of 
pleurisy are less definite; in fact, some of the chest 
pains described above are due to a somewhat disguised 
pleurisy. 

2. Bleeding from the Lungs. Blood-spitting or the 
raising of blood-tinged sputum, by giving timely warn- 
ing, often proves life-saving. If blood has been expec- 
torated, the source of which is in doubt, it should be 
remembered that bleeding from the lungs is not always 
accompanied by cough. In many cases, especially if 



HOW TO RECOGNIZE TUBERCULOSIS 111 

the loss is small, the blood wells up into the mouth or 
throat, and is then removed by a slight clearing of the 
throat, or merely by the act of spitting, cough being 
entirely absent. It is to be regretted that this peculiar 
sequence of events has thrown many a patient and his 
physician completely off the track. 

In other cases it is erroneously assumed that the blood 
comes from the nose or the teeth. Again, altho less com- 
monly, one is led by the observation that the blood spit- 
ting takes place at the time that menstruation is ex- 
pected — menstruation itself perhaps not appearing — to 
believe that the bleeding from the lungs is simply Na- 
ture's way of compensating for the absence of the usual 
monthly period. The fact is, true, simple vicarious 
menstruation is rare, and bleeding from the lungs seldom 
occurs at the time of the expected flow, save when these 
organs are already affected by tuberculosis, or unless 
some other serious condition exists. 

Weighing the Evidence 

He who discovers that he is suffering from any of the 
symptoms mentioned should be on the alert. Rarely 
will all of the symptoms be noticed, perhaps not more 
than one or two. 

The occurrence of one or more of those described under 
group "A" calls for a prompt search for the cause, 
which, especially if not readily found, is likely to turn 
out to be tuberculosis. Altho symptoms of this group 
are among the more common of the earlier evidences of 
tuberculosis, yet, owing to the fact that many other con- 
ditions are accompanied by similar manifestations, it is 
quite obvious that they do not furnish distinctive or 
conclusive proof of the precise nature of the illness. It 
is therefore apparent that every means for shedding 
additional light should be employed. Even then, recogni- 



112 LESSONS ON TUBERCULOSIS 

tion of one's ailment at a period when the signs are few 
is sometimes very difficult; the most painstaking in- 
quiries and examinations by an expert physician in 
some cases failing to decide the matter. On the other 
hand, corroborative evidence is often to be had if a 
search is made for it, and it is surprising how often 
definite signs will crop out if one will only recall the 
history of his illness afresh. For example, if one's age 
is within the limits between which tuberculosis most fre- 
quently develops — the fifteenth to the thirty-fifth year — 
(altho it should be remembered that the disease occurs at 
all ages) ; or if to the symptoms are linked suspicious cir- 
cumstances in the personal or family history, the proba- 
bility that one is suffering from tuberculosis is given ad- 
ditional support. 

Fortunately, if the disease be not recognized until 
symptoms of group "B" appear, the problem is still 
fairly easy of solution. The detection of one or more 
of the manifestations of group "B" alone should lead 
one to form a very definite suspicion. If some of the 
symptoms of group "A" and "B" are combined, the 
probability is very strong. The occurrence of either 
symptom of group " C " — that is, pleurisy or hemorrhage 
from the lungs (unless caused by pneumonia) means tu- 
berculosis in nearly all cases, even tho no other evidences 
be present. The probability is so near a certainty that, 
unless tuberculosis can be positively excluded, the only 
safe rule is to consider that tuberculosis is responsible. 

Tuberculosis a Disease op Ups and Downs 

When one has recognized some sign pointing toward 
tuberculosis, there is a certain feature not appreciated 
by most persons but which should be thoroughly under- 
stood if the evidence is to be accurately weighed. In 
spme cases it is true that after symptoms have once 



HOW TO KECOGNIZE TUBERCULOSIS 113 

appeared the malady continues to make steady prog- 
ress ; but this is exceptional ; characteristically the dis- 
ease has a seesaw course — a course of ups and downs. 

1. The first symptoms will in nearly all cases sub- 
side sooner or later entirely of their own accord. 
Without effort of any kind, the outward evidences of 
the disease disappear, leaving the individual apparently 
no worse for the attack. In some instances he may be left 
a little thinner and have a little less vigor ; but in other 
cases he is fully as strong, has just as much vim, and 
takes as keen an interest in things as ever. 

2. Only in a minority of cases will this spontane- 
ous abatement of symptoms be permanent. A smaller 
group of persons, more fortunate than the rest, will go 
through life with health unimpaired by further out- 
breaks of the disease. In most cases, however, unless 
definite combative measures be put into effect, after 
a shorter or longer period of weeks or months or years, 
during which one's fears are lulled, the disease will break 
out again ofttimes with greater intensity than before. 

Between the outbursts, a few months, or a year or more 
may elapse, while meantime one enjoys nearly perfect 
health. Like the first attack, the second may also sub- 
side without treatment. Later a third, or a fourth out- 
break may occur. Sometimes, like the others, symptoms 
of these attacks, too, disappear, with absolutely no change 
in the mode of life. Quite often each succeeding attack 
becomes a little more severe and prolonged than the pre- 
ceding one, each time leaving a little deeper mark upon 
the individual. In this manner — waves of activity alter- 
nating with periods of quiescence during which one feels 
comparatively well — the malady continues its slow, pro- 
gressive march, until even in the intervals one does not 
feel quite up to par. 

In this connection there is one fact that should be 



114 LESSONS ON TUBERCULOSIS 

indelibly stamped upon the memory: Once outward 
evidence of tuberculosis has appeared, unless the 
proper steps be taken to counteract its effect, in nearly 
all cases the disease will sooner or later make further 
inroads upon the health, and in a majority of cases will 
ultimately cause death. 

False Conclusions and Pitfalls 

It is to be regretted that this peculiar, irregular course 
of tuberculosis has led many into costly error. How 
common it is to hear some sufferer from the disease ex- 
claim: "I've had this same thing before, yet I soon re- 
covered. So I am positive it is nothing serious/ < — there- 
with casting the matter completely from his mind. 

True, the immediate attack may pass away without at- 
tention, but the vital question is: Can one afford to 
neglect a condition whose final outcome is frequently 
so extremely serious? 

Then too, as time goes along and one wave in the dis- 
ease follows another, each may be ascribed to a separate 
cause. In a former era, physicians themselves were fre- 
quently misled as to the precise nature of their patient's 
illness ; for altho they were able to determine the basis of 
the immediate complaint that caused the afflicted per- 
son to seek counsel, not rarely they failed to recognize 
the real root of the trouble. For example, after finding 
that his patient was suffering from pleurisy, the physi- 
cian may have overlooked the tuberculosis, which was 
perhaps the underlying cause; moreover, owing to the 
fact that pleurisy sometimes closely simulates inter- 
costal neuralgia, the physician occasionally made the 
mistake of informing his patient that he was suffering 
from the latter ailment, and from it alone. 

In other instances, due to the fact that tuberculosis is, 
as will soon be explained, sometimes ushered in by pneu- 



HOW TO RECOGNIZE TUBERCULOSIS 115 

monia, or because in still other cases tuberculosis per- 
fectly imitates this disease, the physician diagnosed the 
condition as pneumonia, alone. So, too, the fact that 
throat symptoms frequently accompany tuberculosis has 
in the past again and again led to an erroneous diagnosis 
of "throat trouble" or "throat hemorrhage' ' — without 
detection of the underlying tuberculosis. On the other 
hand, the distress in the throat has sometimes been laid 
at the door of tobacco ; and the victim has been told per- 
haps that he had a "cigaret cough/ ' Occasionally, ow- 
ing to the presence of misleading symptoms on the part 
of the stomach, a diagnosis of "stomach trouble" or 
"stomach cough' ' has been made. In yet other cases, 
the fact that the blood has been deficient in some element 
has been the cause of many a diagnosis of "anemia"; 
without discovery of the source of the anemia — tuber- 
culosis. Similarly, the shortness of breath that some- 
times accompanies tuberculosis has in the past at times 
led the physician to assume that he was dealing with 
pure "asthma." 

Soothing Terms. Years later, owing in part to the 
retention by certain physicians of the old idea that the 
disease was incurable, and partly to the diametrically op- 
posite belief that the tuberculosis would almost cure 
itself, there was a quite pronounced tendency for physi- 
cians to endeavor to console their patients by glossing 
over the real trouble with some less serious-sounding 
name. During this period, in their efforts to soothe the 
fears of the sufferer, well-meaning physicians were ac- 
customed to employ some evasive term as a sugar-coating 
for plain everyday tuberculosis. 

Thus, it not rarely happened that as each new out- 
break of the disease occurred and as the sufferer drifted 
about from one physician to another, each in turn gave 
a new name to the ailment. At one time he was said 



116 LESSONS ON TUBERCULOSIS 

to have a "cold" or to have acquired la grippe, while 
perhaps the next attack was attributed solely to a 
"nervous breakdown.' f Again, the individual was told 
that his " lungs" were "weak," or that he was "threat- 
ened with tuberculosis," and that if he did not watch 
out he would get it; or he was led to believe that his 
lungs were "a little bit congested," but was further 
informed that this was not serious. The next flare-up 
was perhaps laid to a "bronchitis" or to "bronchial 
catarrh"; perhaps the blame for the following outbreak 
was shouldered on to "malaria" or typhoid — and so on. 
Concealment No Longer Tolerated. More recently, 
with the advance of science and of the knowledge of 
tuberculosis, as the realization that the middle ground 
is the right one has gained circulation — that is to say, 
since it has been appreciated that altho tuberculosis is 
curable, yet in order to retrieve his health the sick per- 
son must make genuine and definite effort — it has been 
generally agreed upon that if the patient is to direct his 
efforts intelligently he must be informed of the nature 
of his illness, and the old plan of concealing the facts 
from the invalid is fast falling into disrepute. 

Illustrative Cases 

Case 1. A boy, age 14, who wished to join the gym- 
nastic class of the Y. M. C. A., was examined to determine 
his physical fitness. This youth felt strong, had no 
symptoms of any kind, and to casual inspection seemed 
to be in perfect health. Physical examination showed a 
robust, well-developed body, no abnormality being found. 
On the other hand, a tuberculin test applied to the skin 
gave a positive response; however, the fact that the re- 
action did not appear until three days after the test was 
applied, weighed in connection with the absence of symp- 
toms and the negative results of the physical examina- 



HOW TO EECOGNIZE TUBERCULOSIS 117 

tion, led to the conclusion that while the boy harbored 
somewhere in his body a minute, hidden colony of the 
germs of tuberculosis, the infection was not enough to 
amount to actual disease in the ordinary sense of the 
word. Treatment not being deemed essential, the par- 
ents of the young man were merely informed of the 
facts and counseled to guard him from strain. 

Case 2. A gentleman, age 27, desired an examination 
for the purpose of taking out life insurance. This man 
not only appeared to be in vigorous health, but absolutely 
free of symptoms, was actually enjoying life to the full. 
His weight was normal, and a careful examination of 
his whole body disclosed no deviation from the ordinary. 
Notwithstanding these observations, the routine applica- 
tion of a skin tuberculin test was followed by a late 
positive reaction. The gentleman was informed that at 
some time during life he had acquired a trace of tuber- 
culous infection, which he probably still harbored, but 
was not suffering from tuberculosis, in the generally ac- 
cepted meaning. This gentleman was a first-class risk. 

Case 3. A youngster, a boy whose parents, both 
healthy, had been killed in an accident during his in- 
fancy, had at the age of two been adopted by another 
couple. His foster mother was then afflicted with, and 
continued to suffer for many years, from advanced tu- 
berculosis. As a little fellow the boy was active, tho 
"not very stout"; he was sick from one cause or another 
a good part of the time. His stomach and bowels were 
quite often "out of fix," and at the age of three he was 
"taken down" with the measles — then came the 
mumps — then a severe cold which "almost went into 
pneumonia" — just one illness following on top of the 
other. His appetite was fluctuating, usually poor. 
When he started in school, the fact that his tonsils were 
large caused his teacher to advise that he be examined. 



118 LESSONS ON TUBERCULOSIS 

Inquiry disclosed the fact that in addition to his other 
symptoms he had a fever in the afternoon, and a com- 
plete investigation brought to light a focus of active tu- 
berculosis, which tho fortunately incipient, called for im- 
mediate treatment. 

Case 4. A school teacher, a young lady, age 22, had 
noticed that during the last year it had become neces- 
sary to force herself a little ; that she seemed to be losing 
interest in her work, and was growing decidedly 
"nervous." She now felt quite tired after the day's 
duties were fulfilled, in spite of the fact that the work 
was no heavier than before. During the last few months 
she had been distressed or annoyed at times by a rather 
peculiar ache in her right shoulder and arm. She stated 
that she had no cough or expectoration, and could recall 
nothing else out of the ordinary. Inquiry into her per- 
sonal and family history elicited the fact that at the time 
she was born her mother had "lung trouble" and that 
two years later the mother died of a "long-drawn-out 
pneumonia. ' ' The mother had personally cared for the 
daughter until a short time before death. 

Altho the patient did not think she had lost flesh, 
the scales proved that her weight was five pounds less 
than it had been a few months previous. A two-hour 
record of the temperature kept for two weeks showed 
that she had a fever of 99.5° F. in the evening. A phys- 
ical examination of the chest, as well as the X-ray, re- 
vealed signs of disease. A tuberculin test applied to 
the skin in the usual manner gave, within twenty-four 
hours, a strong response. 

A diagnosis of early "closed" tuberculosis of the lungs 
was made, and the young lady was told that unless suit- 
able combative measures were taken, the disease would 
probably continue to make headway. 

Only half convinced, she did not see fit to give up her 



HOW TO EECOGNIZE TUBERCULOSIS 119 

work, hence could carry out the treatment only in inef- 
fective form. 

Eight months later the patient experienced what 
seemed to be a prolonged attack of the "grippe.' ' 
Finally most of the effects of this attack disappeared, but 
although the cough abated, it did not cease entirely. 
Sometimes the cough was dry and unproductive, but at 
other times was followed by expectoration. Further- 
more, she found herself still quite weak, several months 
after the height of the illness. Samples of the sputum 
were examined and found to contain the germs of tu- 
berculosis (a result of softening or ripening of the tu- 
bercles) ; and other evidence of advance in the disease 
was disclosed. After these disclosures, the patient saw 
the necessity for making real efforts — and eventually she 
regained her health. 

Case 5. A newspaper writer who had always had ex- 
cellent health, at the age of thirty-two began to find that 
the strain of irregular living and long hours was tell- 
ing. The morning's work left him tired and fagged; 
yet a short rest, or a little recreation at the club was 
usually sufficient to give him a new hold on things. 
After a time, however, he found that he did not become 
refreshed so quickly. Moreover, sleep was becoming dif- 
ficult and restless nights rather a common occurrence. 
One day his throat began to annoy him, and a dry, rasp- 
ing cough was added to his difficulties. Ascribing the 
cough to the use of tobacco, he decided to stop smok- 
ing, but found that this did not bring the expected re- 
lief. As time wore on, he tired more and more easily, 
and a long rest was now required to make him feel at 
all like his old self. However, his appetite continued 
good, and his weight normal. 

Rather suddenly one night he was seized with a sharp 
pain in his left side, which became agonizing with every 



120 LESSONS ON TUBERCULOSIS 

breath (pleurisy). Meantime his cough increased, and 
now in the morning he usually raised a half teaspoonf ul 
or so of yellowish-gray sputum. At this period he sought 
medical counsel. 

A glance showed a strongly built man with well- 
devoloped muscles and a large chest — face full, color 
good : apparently an athlete. On the other hand, a pains- 
taking examination brought out positive evidence of lung 
tuberculosis, including the finding of the germs in the 
sputum. 

Case 6. A young man of twenty-five who con- 
templated marriage, said that while he had never been 
really robust, nevertheless until recent years his health 
had stood up as well as the average, despite a life full of 
many strenuous activities. Nearly two years previously 
he had caught a severe "cold," which persisted for seven 
weeks. Since then, he had had five similar attacks. Dur- 
ing the last of these "colds" he had been troubled with 
a soreness on one side of his chest; since then, he felt 
in the same spot a drawing or pulling sensation which 
was often associated with aching. On being asked the 
question : i ' How long since you have felt perfectly well V 9 
the answer brought surprise to his face. He was unable 
to say that he had felt like himself during the last five 
years. 

A careful study of the case, plus repeated examina- 
tions, including the use of the X-ray, finally brought out 
the cause of ill health — tuberculosis. 

The young man was told of the dangers of marriage 
under such circumstances, and was given detailed in- 
structions as to the means of cure. Failing to appreciate 
the true significance of his failing health, or perhaps 
considering that the matter would "blow over," altho 
he decided not to marry, he carried out barely at all the 
plan of treatment. Notwithstanding this apathy, things 



HOW TO RECOGNIZE TUBERCULOSIS 121 

went fairly well until a year or two later, when he was 
seized with a violent attack of genuine la grippe, after 
which the inroads of the tuberculosis became indeed 
rapid. At last, the occurrence of several severe hemor- 
rhages brought the patient to a realization of the seri- 
ousness of his condition; from then on he was an ideal 
patient. 

Case 7. A slender, rather pale young man, age 
eighteen, complained of feeling feverish at times during 
two preceding months. He said that he had noticed that 
he perspired more than usual, and that often when he 
became a little excited the sweat would trickle down 
his right arm. Several times while asleep — once when 
he was sleeping in the daytime, the other times at night — 
he broke out in a profuse perspiration. 

Responding to questions, he said that his brother, who 
had been his bed-mate since infancy, died of consump- 
tion when he (the patient) was four years old. He stated 
further that he had never been strong, and that so far 
as he could remember he had always suffered from 
"catarrh," which made it necessary for him to clear his 
throat or to cough frequently. This "catarrh" had been 
worse during the period that he had the feverish sensa- 
tions. He felt weak at times and had lost a few pounds 
weight. 

A specimen of sputum, which the patient said differed 
not at all, either in appearance or in the manner in 
which it was brought up, from the supposed catarrhal 
sputum that he had raised for years, contained many 
tubercle bacilli. Upon this finding, supported by other 
evidence, the diagnosis of a slowly progressing low-grade 
tuberculosis, which had existed for years, but which had 
recently flamed up anew, was made. 



122 LESSONS ON TUBERCULOSIS 

Misleading Symptoms 

If one understands that the poisons from the seat of 
disease are carried in the blood stream to all parts of the 
anatomy ; that the vagus nerve (which supplies the lungs 
with nerve fibers) also sends branches to many other 
organs, including the stomach and bowels, the liver, the 
heart, the throat and the voice-box, and the ear ; that this 
same nerve is but a link in the immense and intricate net- 
work of nerves with antennae reaching to the body 's most 
distant recesses; that the destruction of lung tissue in 
the course of the disease, and later, the contraction of 
the scar that replaces the destroyed tissue, produce 
mechanical disturbances in the lungs, as well as in the 
nearby organs ; that in one or other of these ways or in 
other manner, the function of the heart is likely to be 
disturbed (this in turn interfering with the proper cir- 
culation of blood throughout the body) — if these facts 
be recalled, one is not surprised to learn that the out- 
ward evidences of disease of the lungs ofttimes appear 
in other organs, or in parts of the body far from the 
focus of disease. 

In some cases manifestations of this character (vari- 
ously named, reflex, referred or sympathetic symptoms) 
are so prominent as to overshadow — at least, for the time 
being — the more positive and definite signs. However, 
even in such cases, if one will reflect on the matter, there 
will usually come to light some of the more distinctive 
earmarks of tuberculosis which will put one upon the 
right track. 

Examples of Deceptive Cases 

Case 8. A cigar-maker, age 33, a moderate smoker, 
who had never before been seriously sick, of excellent 
physique, had first experienced some nine months previ- 
ously a difficulty in carrying on a sustained conversa- 



HOW TO RECOGNIZE TUBERCULOSIS 123 

tion. Altho his voice was clear, speech required more 
than ordinary effort and his throat frequently felt tired. 
After a while, moreover, his voice became husky; in a 
short time it was lost almost completely. Still later, after 
he had passed a month virtually without speaking, his 
voice again grew stronger and for quite a period was 
practically normal; yet ever since this attack he had 
been now and then distressed with an indefinite aching 
or an uncomfortable full feeling in the throat, which 
caused him to hawk and spit. During the last two weeks 
the hoarseness had begun to trouble him anew. 

This was all that he complained of, but questioning 
brought out that during the last six months his strength 
had been below par and that he had been noticeably 
nervous and irritable — ofttimes unaccountably "blue" 
and at other times rather careless of what happened. 
Now and then an odd fluttering in the neighborhood of 
his heart had led him to wonder if this organ was not at 
fault. His appetite was not good, and he was seven 
pounds under his average weight. On some days, espe- 
cially when he was very nervous or tired, he had been 
distressed by a disagreeable feeling of pressure or a dull 
pain over the upper part of his right side and in his right 
shoulder. 

The thermometer showed that his temperature jumped 
up more than it should as the result of excitement or 
slight exertion and other small causes. Repeated exam- 
inations of his throat with a mirror showed no evidence 
of tuberculosis in this situation. Examination of the 
chest, on the other hand, disclosed abnormal signs in the 
right lung; and tubercle bacilli were found in the 
sputum. 

Case 9. A lady, age twenty-four, who had previously 
been well, said that she had been cared for a good deal 
during childhood by a cousin who at that time was 



124 LESSONS ON TUBERCULOSIS 

troubled with a " loose" chronic cough, and who was 
later informed that she had tuberculosis. In the year 
just passed, the patient had nursed her husband through 
a protracted siege of illness (not tuberculosis) a period 
during which both her physical and mental strength was 
sorely tried. She stated further that she had not men- 
struated for three months; that recently she had been 
distressed by gas on the bowels, that she had had sev- 
eral spells of vomiting, and two attacks of diarrhea 
associated with cramps. Her appetite had almost en- 
tirely disappeared. She asserted that she felt very much 
"run down" and that she had lost flesh, altho she did not 
remember her former weight. On close questioning, she 
finally recalled that she had been troubled at times by a 
"nervous cough" and that she occasionally raised a little 
sputum. 

A thorough examination of the pelvic organs was 
made, but no abnormality of the generative system was 
discovered. Specimens of her blood showed an anemic 
condition (deficiency in iron and corpuscles). Atten- 
tion given to the stomach and bowels brought out no 
structural change from the normal. Examination of the 
lungs, however, revealed pronounced signs; and the 
diagnosis of tuberculosis was confirmed by the detection 
of the germs in the expectorated matter. The patient 
was told that the absence of the monthly periods need 
cause no concern, as this was apparently a conservative 
effort of Nature that required no treatment. 

"Galloping" or "Hasty" Consumption 

Altho, as previously stated, in the great majority of in- 
stances tuberculosis creeps upon one very gradually, 
there are a few cases in which the symptoms develop so 
rapidly that the individual is desperately ill almost from 
the outset. This acute type of the disease, known as 



HOW TO RECOGNIZE TUBERCULOSIS 125 

" hasty' ' or "galloping" consumption, is often ushered 
in by an outbreak of symptoms that bear a striking re- 
semblance to ordinary pneumonia; the similarity often 
being so marked that the true nature of the illness is 
discovered only when the sick person fails to convalesce 
promptly. The mortality is high in such cases ; but even 
so, one has the consolation of knowing that if death is 
to be his lot, it will probably come soon. Furthermore, 
it is fortunate that in some of the more favorable cases 
of "galloping" tuberculosis, when improvement once 
sets in, it, like the onset of the malady, may progress with 
corresponding rapidity. In other instances the first step 
toward recovery is a change in the type of disease to 
the milder, familiar chronic form. 

Fibroid Tuberculosis 

A Very Mild and Slow Type. By way of contrast 
with the severe and rapid form of tuberculosis just de- 
scribed as " galloping' ' consumption, it may be noted that 
there is another variety of the disease that is exceedingly 
chronic and extremely mild — fibroid tuberculosis. This 
type, named "fibroid" because of the large amount of 
fibrous tissue (healing tissue or scar) that is built up in 
the lung, runs an extremely slow course — a course that 
is frequently drawn out for ten or twenty years, and 
occasionally thirty years or longer. During this whole 
period, fever may not be detected and the few symptoms 
of the disease are added so slowly that it is necessary 
to be alive to their significance if the cause is to be dis- 
covered in time. It is well for it to be understood, how- 
ever, that there is no radical distinction between this 
and the other varieties of tuberculosis, the distinction 
being merely one of degree. 

The milder character of this low grade type of the 
disease is due partly to the fact that there is but little 



126 LESSONS ON TUBERCULOSIS 

" breaking down" or softening of tissue. Again, the 
inroads of the malady appear so slowly that even to 
Nature they are all but imperceptible. Hardly awake 
to the menace, Nature puts up only a sluggish fight ; the 
consequence being that altho an effort is made at healing, 
the formation of scar tissue often fails to quite catch up 
with the advance of the disease. In this manner the dis- 
ease wanders through the lungs, the scar development 
just about keeping pace with, but lagging always a little 
behind, the advance of the disease process; the upshot 
being that the extensive overgrowth of scar replaces the 
destroyed lung cells and, as it contracts, produces serious 
mechanical disturbances in the heart and other sur- 
rounding organs. Thus incidentally, as the growth of 
scar becomes widespread throughout the lungs, shortness 
of breath and blueness of the lips, etc., are apt to be- 
come quite noticeable. 

The presumption is natural in such cases that a slight 
change in living conditions would be sufficient to restore 
the balance in Nature's favor. As a matter of fact, ex- 
perience has confirmed this conclusion; for as a rule 
fibroid tuberculosis responds very readily to treatment. 

Fibroid Tuberculosis Not to Be Neglected. How- 
ever, one who is afflicted with this variety of tuberculosis 
should not assume that because the manifestations are 
slight, measures for recovery are unnecessary. He should 
understand not only that fibroid tuberculosis tends in the 
long run to make one a sort of cripple and to shorten 
one's days, and is eventually liable to prove fatal, but 
should realize also that at any time it may change into 
one of the more rapid and more dangerous types. For 
these reasons he should at once put his heart into a real 
and earnest fight, with no let-up until the disease has 
been completely conquered. 



HOW TO KECOGNIZE TUBERCULOSIS 127 

What to Expect from One's Physician 

In order that one may be prepared to help one's medi- 
cal adviser in every way possible, it seems well to give 
some idea of the customary procedure followed by the 
up-to-date physician in dealing with cases that may pos- 
sibly be tuberculosis. 

Elements of a Thorough Investigation. In addition 
to answering the questions put to him by the physician, 
a thorough examination of the chest will be required. 
For this purpose it will be necessary to strip the body 
to the skin, as an examination made through even a thin 
garment is almost worthless. The physician may also 
desire to make, or have made, an examination of the 
chest by the X-ray ; he may in addition wish to make a 
general examination of the whole body and may request 
samples of the blood, urine, etc., for analysis, or may 
deem it wise to make other tests. If one raises sputum, 
the physician will probably wish to examine at least 
one specimen. In this connection, before asserting def- 
initely that he has no sputum, it is important for the 
patient to make certain that in fact he is not unwittingly 
swallowing the sputum immediately after it is raised. 
Unless the physician requests otherwise, when saving the 
sputum, one should collect and submit every particle that 
is spit out. Under no circumstances should one take for 
granted that the expectorated matter comes from the 
throat, and therefore withhold part of it from the speci- 
men. 

The Expert May Detect Tuberculosis Before Germs 
Appear in the Sputum. Here let it be made clear that 
the diagnosis of tuberculosis can often be made before 
the germs appear in the sputum, and that, furthermore, 
in a few cases (for example, fibroid and "closed" tu- 
berculosis) the disease runs its course from beginning 



128 LESSONS ON TUBERCULOSIS 

to end, yet bacilli are at no time expectorated. In short, 
in doubtful cases, the finding of the germs of the disease 
in the sputum will clear up the diagnosis ; in other cases, 
however, the tuberculous nature of the condition may 
be fully established by other means ; bacilli in the sputum 
are then unnecessary to the diagnosis. In such instances 
it is folly to waste valuable time waiting for their ap- 
pearance. (See Case 4.) 

In certain cases it is necessary for the sick person to 
keep a record of his temperature, and perhaps of his 
pulse, for a considerable period — say, every two hours for 
a week or more. 

In Doubtful Cases Repeated Examinations and Pro- 
longed Observations May Be Necessary. Ofttimes the 
physician will be unable to arrive at a definite conclusion 
on the first visit ; it may even be necessary for him to fol- 
low the case along for some days or weeks, re-questioning 
his patient from time to time, making a new examination 
occasionally ; thus making his study of the case a sort of 
serial affair. If in the intervals one will think over 
things in the light of the physician's questions, facts 
which will be of considerable aid but which were for- 
gotten during the former consultation will often be re- 
called. 

In many cases a tuberculin test may appear advisable ; 
again inoculation of an animal with sputum suspected 
to contain tubercle germs (the germs perhaps being so 
few in number that searching for them in the ordinary 
manner is like hunting for the proverbial needle in the 
haystack) for the purpose of ascertaining whether or 
not tuberculosis is established in the animal — or the 
X-ray, will be of assistance in throwing light on the sub- 
ject. 






HOW TO RECOGNIZE TUBERCULOSIS 129 

The Tuberculin Test and Its Use 

"What Is the Tuberculin Test? Is It Safe? Should 
I Permit Its Use?" In answering these common 
queries, it may be stated that tuberculin is a substance 
prepared from dead tubercle germs, which, when inocu- 
lated into the body of a tuberculous individual, produces 
(with certain well-defined exceptions) a characteristic 
response known as the tuberculin reaction. According 
to the manner in which the test is made, this reaction may 
be detectable (1) locally, at the point of application; (2) 
at the seat of disease; or (3) as a general phenomenon, 
accompanied by fever or the like; or it may manifest 
itself in more than one of these ways. 

The danger from the general test, when carefully and 
intelligently administered, is so nearly nil that it may 
ordinarily be disregarded. However, inasmuch as just as 
valuable information can usually be gotten by using one 
of the local skin tests, and as the fever reaction is some- 
what disagreeable, the general test is not ordinarily called 
for. The skin tests are entirely harmless, have no ob- 
jectionable features, and when properly interpreted (as 
indicated in illustrative cases Nos. 1, 2 and 4) may give 
considerable help to the physician. 

Tuberculin is sometimes applied to the eye. In the 
great majority of cases this proceeding is harmless, but 
in rare instances injury has resulted. For this rea- 
son, and because equally reliable information can usually 
be obtained by the other tuberculin tests, the eye test 
should not be employed except in extraordinary cases. 

What Is the Value of X-ray in Diagnosis?* 

It is quite common for either too high or too low an 
estimate to be made of the power of the X-ray to detect 

* A discussion of the value of the X-ray as an aid to recovery 
may be found in Lesson XV. 
9 



130 LESSONS ON TUBERCULOSIS 

and differentiate structural alterations in the lungs. The 
fact is, altho in the hands of an expert at times exceed- 
ingly helpful in throwing light on the nature of one's 
illness, the X-ray is by no means infallible. Like other 
agencies useful in their place, it, too, has inherent 
deficiencies. As an example of its limitations, it may 
be stated that in the shadows cast by the X-ray the evi- 
dences of early or slight tuberculosis are sometimes en- 
tirely lacking; again, the scars of healed tuberculosis 
are with difficulty distinguished from areas of active or 
progressive disease — so the value of this agency as a 
diagnostic aid is for these reasons considerably lessened. 
In most cases a careful consideration of all other factors 
will lend accuracy to the diagnosis. Occasionally, how- 
ever, as, for illustration, if the area of the disease be 
centrally located (that is, so far from the surface as to 
be indetectable by ordinary methods), and if the re- 
sults of the X-ray examination be weighed in connection 
with other evidences, the X-ray may prove of pronounced 
value. So also, the X-ray is invaluable in recognizing 
certain complications of tuberculosis. Then, too, during 
war time, in the routine examinations of large bodies of 
soldiers, the X-ray is of more than ordinary utility. This 
is so in part because the history of the case for one rea- 
son or another may be over or under colored by the ap- 
plicant, and because — under such circumstances — at best 
only a limited time can be given to investigation of the 
case by the usual methods. 

On Making Tour Own Diagnosis 

Those of you who have reason to suspect that you are 
suffering from tuberculosis, are very strongly advised to 
place your case in the hands of a physician for final de- 
cision. Tet certain circumstances may force upon you 
the necessity of diagnosing your own case. If this be- 






HOW TO RECOGNIZE TUBERCULOSIS 131 

comes necessary, with reasonable care in estimating the 
pros and cons, you will very likely be able to decide the 
matter with sufficient accuracy to justify you, if the 
verdict is in favor of tuberculosis, in at once instituting 
measures to eradicate the disease. 

If this course must be followed, there are several 
matters now to be discussed, to which special attention 
should be paid. 

One's Feelings Not a Trustworthy Guide to Fever. 
The fact requires emphasis that the feelings are not to 
be relied upon in deciding whether or not the sick person 
has fever. On the one hand, it is quite frequently the 
case that the patient who has no fever, will seem so hot 
and flushed that he is convinced that his temperature is 
above normal. (In this connection, however, it should 
be remembered that these hot flushes simulating fever are 
also common accompaniments of tuberculosis, tho of 
course by no means peculiar to it.) On the other hand, 
many and many a person having considerable fever has 
been sure in his own mind that he had none. (In such 
instances fever sometimes has an effect similar to a drink 
of whisky, serving to cover up the ill feelings of the 
sufferer, so that he actually feels better and even ex- 
hilarated at this time.) In neither case can the feelings 
be accepted as an accurate guide. 

The Use of the Thermometer. For these reasons it 
is very necessary that a thermometer be used if it is to 
be ascertained definitely whether or not one has fever. 
That the test may be free from error, the temperature 
must be taken at regular intervals over quite a period. 
This means that in doubtful cases the temperature should 
be taken every two hours, except during the night, for not 
less than one week. 

In taking the temperature the bulb of the thermometer 
should be placed well beneath the tongue, and the mouth 



132 LESSONS ON TUBEECULOSIS 

kept closed for three minutes or more — longer during 
very cold weather. It will be well to establish this three- 
minute rule even tho it is claimed that the thermometer 
will register in a minute or less. It is not advisable to 
take the temperature for at least fifteen minutes after 
taking either a hot or cold drink. Previous to placing 
the thermometer in the mouth, one should see that the 
mercury is well down toward the bulb. On hot summer 
days the act of " shaking down" the mercury should be 
performed just before the temperature is taken; for 
atmospheric heat sends up the quicksilver the same as 
does the heat of the body. 

The Normal Temperature of the Human Body. In 
interpreting the readings of the thermometer, it is im- 
portant that one be acquainted with the temperature of 
the body when in health. This, tho varying slightly in 
different individuals, has fairly definitely fixed limits. 
It should, however, be understood that normally the tem- 
perature does not remain constantly at one point; but 
has, or may have, a daily range of about one degree and 
a half, Fahrenheit. The mouth temperature of the aver- 
age healthy adult, during rest, varies with remarkable 
consistency between about 97° F. on awakening or dur- 
ing the early morning, and 98.6° F. at its acme, the 
highest point being reached at any time between noon 
and ten P. M., or exceptionally at other hours. 

Under ordinary conditions the temperature seldom 
extends beyond these bounds, except as now to be 
noted : — 

Some Exceptions. For a few persons, especially those 
of nervous temperament, the maximum temperature is 
slightly higher. However, the mistake should not be made 
of assuming without investigation that nervousness, 
alone, is the cause. It should be recalled that nervous- 
ness is often merely the outward expression of some 



HOW TO RECOGNIZE TUBERCULOSIS 133 

deeper trouble, which not infrequently will be found to 
be tuberculosis. Undue mental excitement, such as may- 
be occasioned by fright, great joy, or the reading of 
an exciting story; severe muscular exertion; extreme 
changes in the temperature of the surrounding air ; the 
eating of a very heavy meal ; constipation and other dis- 
turbances of the stomach or bowels — all these influences 
produce perfectly natural changes in the bodily tem- 
perature. In health, the variations thus occasioned are 
as a rule scarcely noticeable, usually amounting to not 
more than a few tenths of a degree, and are ordinarily 
only occasional and temporary. Those who are suffering 
from tuberculosis, on the other hand, will probably find 
that the fluctuations are more pronounced. 

A Rise in Temperature at or Near Menstruation 
Common. Women who are keeping a record with the 
thermometer are likely to observe that the temperature 
has a rather characteristic rise, as the case may be, pre- 
ceding, during, just following, or between the monthly 
periods. This so-called menstrual wave, which may last 
from a few days to two weeks, is fairly common and, 
so long as it remains within reasonable confines, seems 
to be perfectly normal ; a rise at this time, therefore, need 
cause no especial concern if not higher than a half, or at 
most a degree, and if not accompanied by other sus- 
picious manifestations. The absence of the menstrual 
wave has no significance. Tuberculosis often causes the 
rise to be higher ; so, too, other symptoms such as cough 
and expectoration are liable to be worse, or may appear 
only at this time. 

Variations During the Extremes of Life. One 
should bear in mind also that during infancy and child- 
hood the normal temperature is on the whole a little 
higher, and in old age somewhat lower, than during 
middle life. 



134 LESSONS ON TUBERCULOSIS 

The Error of Discounting Your Preliminary Con- 
clusions. Lest the wish prove father to the thought 
it is well for you to be sure that you do not per- 
suade yourself against your better judgment, or allow 
others to delude you into the belief that your symp- 
toms are due to some minor ailment. If fairly con- 
vinced that your symptoms are due to tuberculosis, 
you should fortify yourself against making the mis- 
take that many have made of discrediting this con- 
clusion solely because your appearance is robust, because 
the symptoms have existed for quite a long period — it 
may be, even many years — with seemingly no serious ef- 
fect, or because at some previous time you have suffered 
from similar attacks from which you readily recovered. 
As a matter of fact, the occurrence of previous outbreaks 
of similar character adds weight to the belief that tu- 
berculosis is the cause. Furthermore, as experience has 
thus taught you that the subsidence of symptoms has not 
been permanent, the probability is large that, if left 
alone, the disease will continue to advance. 

Should One Wait to Make Sure? If with ap- 
proximate exactitude in your own mind, you have estab- 
lished the diagnosis of tuberculosis, it is as a rule a 
mistake to wait long in order to make sure. A delay 
of even a month or two will make recovery less certain 
and may even spell failure. Inasmuch as the measures 
useful against tuberculosis are simple, and as they offer 
a large chance of benefit whatever the cause of your ail- 
ment, if you have made reasonably sure it is strongly 
advised that definite steps toward recovery be taken at 
once. 



LESSON VI 

YOU AND YOUR PHYSICIAN 

In the preceding lessons the invalid has been advised 
against relying entirely upon his own resources, either 
in diagnosing the disease, or in making the fight against 
it, unless this course is forced upon him. Under all other 
circumstances he is strongly urged to put himself entirely 
in the hands of some competent physician whose advice 
he will abide by. However, before entrusting the con- 
duct of his case to any physician, it is important to make 
sure that the physician is well qualified to deal with tu- 
berculosis; for there are quite a number of physicians 
who do not have these qualifications — a fact which has 
often made it difficult for the sufferer to obtain a prompt 
and correct diagnosis, or to secure proper treatment. It 
is to explain how it has come about that a considerable 
number of physicians have found difficulty in dealing 
with so ancient and common a malady that the follow- 
ing paragraphs are written. 

The Cause of a Peculiar State op Affairs 

In a general way, it may be said that in the past, two 
obstacles have blocked the path of progress in the knowl- 
edge of tuberculosis. Most physicians who have attained 
renown through their ability in coping with the disease, 
as a preliminary to success have had to overcome (1) the 
handicap of inadequate training, (2) the limitations on 
their opportunities for personally observing and study- 
ing the disease. In a moment it will be shown that the 
second item is, strange as it may seem, due principally 

135 



136 LESSONS ON TUBERCULOSIS 

to the inherent peculiarities of the disease itself. A lit- 
tle later, suggestions that will aid one in recognizing the 
competent physician, will be given. For the present, 
however, it seems worth while to spend a little time in 
viewing the first item more closely. 

1. Inadequate Training. The root of the difficulty 
is that the course of study in medical colleges is over- 
crowded. There is too much for the student to learn in 
four, or even in five years. Some subject must be 
slighted, and, strange indeed, one of the most prevalent 
of serious ailments, tuberculosis, has often been the sub- 
ject most neglected. 

To-day one of two extreme and opposite views prevail 
concerning tuberculosis: (a) The disease is still held by 
a few to be almost incurable, (b) By others, it is con- 
sidered so easily curable that it is reckoned as virtually 
healing itself. As may be surmised, those on each side 
of the question have in the end reconciled their conflict- 
ing beliefs by reaching through different routes the 
identical conclusion that small good will come from ef- 
forts directed toward recognizing and treating the 
malady. 

One or the other of these opinions has been quite com- 
mon not only among the public in general but also, altho 
to a less extent, among physicians. Even more un- 
fortunately, these ideas have to some extent been accepted 
by those who have had charge of arranging the course 
of study in medical colleges. The consequence has been 
that until comparatively recently instruction on this 
very important disease, in many schools, has been scant, 
and not rarely untrustworthy. In the last few years a 
broadening education on the subject has resulted in the 
introduction of a more thorough and dependable teaching 
along this line, so that the more recent graduates are 
much better equipped to deal with tuberculosis. 






YOU AND YOUR PHYSICIAN 137 

2. Limitations on the Physicians' Opportunities for 
Personally Observing and Studying the Disease. A 

second factor that adds to the difficulties of the situa- 
tion is found in the inherent nature of the disease itself. 
Because the course of the average case of tuberculosis is 
very irregular and marked by many periods of ups and 
downs, and also because the illness is drawn out over a 
period of years, it is seldom possible for the physician in 
general practice to keep close tab on the individual 
patient throughout the complete course of the disease. 
For this reason it frequently comes about that the phy- 
sician does not know what ultimately happens to his 
patient. 

Moreover, up to a certain point, tuberculosis has a pro- 
nounced tendency to respond both favorably and fairly 
rapidly to slight alterations in the mode of living. It 
is not rare for a patient even in an advanced stage of 
tuberculosis to improve remarkably in a very short time. 
The change for the better is, in fact, often so decided that 
after spending only a few weeks or months under suit- 
able conditions, the former frail and feeble invalid has 
become — in all outward aspects — entirely well ; yet true 
healing in the lungs may lag far behind. 

Now if it is recalled that the new threads woven by 
Nature to take the place of those damaged by ill health 
are at first only too easily unraveled by any little back- 
sliding; and if it be further realized that just at this 
danger period (when he has begun to feel and to appear 
well) the patient is likely to suddenly terminate the re- 
lationship with his physician, leaving the latter with the 
impression that his patient has been cured — looking at 
the matter from this angle, we see how natural it is for 
the physician to feel and say, as he often has: "If good 
results can be obtained so promptly and surely when the 
disease is advanced, what will be gained by making an 



138 LESSONS ON TUBERCULOSIS 

effort to diagnose the condition earlier ? Likewise, even 
tho I should run across a case of tuberculosis in its in- 
cipiency, will it be wise to wound the sufferer 's feelings 
by telling him the truth about his ailment, when he will 
regain his health just as assuredly without this knowl- 
edge ?" 

Here is the answer : After the patient has passed from 
under the watchful eye of the doctor, all too frequently 
it is not long until the improvement mistaken by the 
physician for true recovery proves to be only a mirage, 
luring the victim on to a further and further disregard 
for the rules — a counterfeit show of health which is 
liable to be soon lost if the former habits of life are 
resumed too early. 

In this manner it is made evident how hard it is for 
the physician to believe that the disease is really serious 
and to appreciate the necessity for prompt and prolonged 
treatment (even tho he has been taught that this is true), 
unless he has observed many cases from beginning to 
end — which means, as a rule, over a period of years. In- 
asmuch as the physician seldom chooses this line of en- 
deavor at the outset, it is not often that he is given 
the chance to study the disease at first hand unless some 
whim of Fate — some unusual turn of events, such as tu- 
berculosis in his own family — has led him to devote an 
extraordinary amount of time and attention to the sub- 
ject. 

Incidentally, it may be noted that probably every phy- 
sician who has at one time been engaged in general 
practice but who has later been drawn or forced — so to 
speak — into specializing in tuberculosis, can then look 
back on his earlier years of practice and recall more 
than one instance of slight or even extensive tuberculosis 
that he had passed over honestly — perhaps without the 
remotest suspicion of the real trouble. 



YOU AND YOUR PHYSICIAN 139 

How Evasive Terms Have Caused Disaster 

A few decades ago when tuberculosis was quite gen- 
erally held to be incurable, it was a fairly common prac- 
tice of physicians to endeavor to keep the true nature 
of the patient's illness from him by calling the disease 
by some other name in place of straight out-and-out tu- 
berculosis. Altho in late years this plan has largely 
fallen from grace, there are still a few physicians who, 
actuated by the highest motives, continue the habit of 
glossing over the facts by using some term designed to 
avoid wounding the feelings of the sufferer, and to pre- 
vent what the physician conceives to be unnecessary 
worry and alarm. 

Such a physician conscientiously believes that his pa- 
tient's interests are best served by the withholding of 
the truth ; the more so if the patient has come to him for 
some other ailment, or without suspecting tuberculosis. 
Hence, even to-day it sometimes comes to pass that in- 
stead of explaining to the patient that he is suffering 
from tuberculosis but that the disease is curable under 
proper conditions, the physician leads the patient to be- 
lieve that he merely has "weak lungs,' ' that he is 
"threatened with tuberculosis," or applies some similar 
term aimed to allay the fears of the sufferer. Perhaps the 
physician qualifies his summing up of the case with the 
remark that if his patient fails to take care of himself 
properly he will be in danger of breaking down with 
tuberculosis. 

How Some Physicians Look at the Matter. The 

physician is thoroughly convinced that if the facts are 
placed before the patient in their true light, the latter 
will be caused much mental suffering, which will have a 
tendency to retard his recovery. Moreover, if the pa- 
tient is suffering from fairly early tuberculosis, because 



140 LESSONS ON TUBERCULOSIS 

he feels and appears so nearly well, the physician be- 
lieves that if he emphasizes the importance of radical 
combative measures, the sufferer will feel that the doctor 
is given to unintentional exaggeration. Thus, the phy- 
sician points out, that once having lost confidence in his 
medical adviser, the patient will be apt to give little 
heed to subsequent directions and, in fact, will be quite 
likely to seek other counsel. In this event, the physician 
adds, it is fairly probable that sooner or later the suf- 
ferer will meet with another doctor — a doctor who, less 
well informed on the subject, assures his patient that his 
lungs are sound. Then, like more of us, ready and will- 
ing to accept the more hopeful view, the chance is large 
(continues the physician) that the deluded victim will 
eagerly pounce upon the last physician's words as con- 
clusive proof that the fears of the first doctor were 
unfounded, and will cast care to the winds. Later, when 
forced to pay a penalty for each hour of delay, he may 
find to his sorrow that the day when a new lease on 
health could have been obtained at minimum cost, has 
slipped by unnoticed. 

How plausible this explanation! Yet how often the 
story turns out otherwise : how often the warm hearted 
physician's well-meant camouflage fails to serve the pur- 
pose for which it was intended ! 

Nevertheless, tho the patient may subsequently have 
had a turn for the worse (which may have proved wholly 
disastrous), the physician may be entirely unaware of 
this occurrence, and is apt to go along for years, all the 
time assuming that his course has vindicated itself. So 
far as he saw before the patient drifted from his sight, 
the plan worked perfectly. So he has now reached the 
set conviction that through the use of a simple and harm- 
less subterfuge, he held his patient under control and 
kept him always on safe paths. 



YOU AND YOUE PHYSICIAN 141 

What Really Happens. That there is a grain of 
truth in this view and that such a plan works satisfac- 
torily in a few cases, is unquestioned. It is my firm be- 
lief, however, anchored in experience, that concealment 
rarely achieves the hoped-for end, and that favorable re- 
sults from this plan are quite exceptional. The fact 
remains that in the immense majority of such instances 
the sick person cannot, or will not, see the necessity for 
giving sufficient time and attention to his condition, 
unless he realizes definitely that it is serious. He will 
not adhere to a regimen that he may look upon as irk- 
some, involving a sacrifice of some sort, unless convinced 
that this step is vital to recovery. The knowledge 
that he has tuberculosis is the concrete proof that 
he needs, ere hq really puts his heart and soul into the 
fight. 

If the plan of withholding the facts be put into effect, 
the usual sequence of events is this : For a limited time 
the invalid carries out the program the physician has out- 
lined. True, he is apt to dilly-dally a good deal, but 
none the less he does modify his habits sufficiently to 
obtain a measure of good. In this case he is almost sure 
to secure some benefit — temporary tho it may be. Pres- 
ently, satisfied with the progress he has made, "patched 
up, ' ' but by no means well, he allows himself to go with 
the current, drifts away from his physician into the 
doldrums of indifference, and very possibly moves to 
another locality. Growing more and more apathetic, in 
a short time he slips back into his old habits and, after a 
longer or shorter interval, finds himself again in the 
clutches of the malady — probably even more firmly in its 
grasp than before. More : when at last he discovers the 
true state of affairs, he is almost certain to blame his 
former physician for not accurately informing him. 

The rule holds good that the adult who has placed 



142 LESSONS ON TUBERCULOSIS 

his trust in a physician is, except under very extraor- 
dinary circumstances, entitled to the truth. This is 
so, particularly if the patient has tuberculosis specifically 
in mind when seeking advice; but the rule should also 
apply even tho the physician runs across the condition 
by accident — as it were — while making an examination 
for some other supposed difficulty. If the matter be 
laid before him in a plain tho gentle and kindly manner, 
the afflicted person will in the great majority of instances 
be far more likely to cooperate with his physician than 
if some vague or evasive and pacifying term is applied as 
a varnish to cover the actual events. 

It is rare indeed that realization of the truth carries 
with it serious consequences. Often the patient is 
already suspicious. Suspense produces worry, for which 
there may not be the slightest basis. Moreover, it has 
been my experience that certainty either for or against 
tuberculosis usually brings relief. As the mist of doubt 
is wafted away the soul of the sufferer is warmed by the 
glorious sunshine of hope. His vision now clarified, he 
no longer hesitates in indecision, but resting easy in the 
knowledge that knowing the enemy half wins the battle, 
he proceeds to frame his plans accordingly — all the time 
looking ahead confidently toward ultimate victory. 

The Protection of Others Is Another Reason Why 
the Sick Should Be Acquainted with the Facts. It is 
not alone for his own sake that the sick person should 
be acquainted with the facts. If he is to fulfil his duty 
to those around him, it is incumbent upon him to put 
into effect certain precautionary measures (described in 
Lesson III). He cannot be expected to do this intel- 
ligently, and probably will not do so at all, unless the 
exact nature of his ailment is placed before him. Here 
then, again, is further evidence that the straight fact 
is safest and best. 



YOU AND YOUR PHYSICIAN 143 

Tuberculosis Requires a SpeciaijIst 

Taken as a whole, the facts just revealed justify the 
conclusion that tuberculosis requires the services of an 
expert. That this statement may not lead to a mis- 
understanding, it seems best to say promptly that this 
does not mean that it is always necessary or even profit- 
able for one to put oneself into the hands of a physician 
who deals exclusively with this disease. Some physicians 
in general practice have been brought into intimate con- 
tact with so many cases of tuberculosis that they have be- 
come highly proficient in handling it. In this case, 
the fact that the physician's practice includes a certain 
amount of general work, often works out to advantage. 
Thus, the doctor's experience along parallel lines serves 
to balance his judgment when dealing with tuberculosis, 
and also aids him in meeting in effective manner any 
complicating illness of other nature which may perchance 
arise during his supervision of the case. Yet this is 
really the exception that proves the rule : Unless one 
has positive assurance that the family physician also 
has a satisfactory knowledge of tuberculosis, so long 
as conditions continue as at present one will as a rule 
fare better by placing one's trust in the hands of a 
specialist on tuberculosis and allied conditions. 

In this connection it is impossible to emphasize too 
strongly the importance of consulting the best physician 
obtainable, even tho his services come high. Expert ad- 
vice is a sound investment that will be repaid many fold 
in health, time and money. In order to secure depend- 
able counsel, it may even be advisable for one to make 
a journey at some sacrifice. This holds true regardless 
of whether counsel is sought for the purpose of obtaining 
a diagnosis, or for treatment. 



144 LESSONS ON TUBERCULOSIS 

How to Be Sure that You Have Found the True 

Expert 

You will ordinarily recognize the true specialist by 
the fact that he is unlikely to advertise (for advertising 
tends to make for commercialism at the cost of the pa- 
tient's interests). Nor, especially, does he make glowing 
claims concerning the wonders that he can accomplish 
with some particular remedy. Rarely will he make a 
"snap" diagnosis. He is likely to inquire carefully into 
the history of the illness, into the invalid's family his- 
tory, etc. ; finally he will wish to make a thorough, pains- 
taking examination of the chest (with clothing removed), 
and will perhaps desire to examine other parts of the 
body. He may ask the sick person to supply him with 
one or many samples of his sputum, and it may be neces- 
sary for him to repeat his examinations several times 
or to renew his questions. In some cases, he may be 
obliged to extend his observations over a period of one 
or several weeks. He may deem it advisable to apply a 
tuberculin test, or other tests, and it is not unlikely that 
he will wish to analyze the urine, to examine the blood, 
etc. 

The real specialist who has the interest of his patient 
at heart will show a tendency to deliberate equally long 
before informing his patient either that he has been at- 
tacked by tuberculosis or that his fears are groundless. 
He will not make use of deceptive terms. 

While in giving his advice he will employ a sympa- 
thetic tone, nevertheless he will be firm and insistent that 
his definite instructions be followed. Thus, for example, 
he will not merely say: "Oh, take things easy, sleep out 
of doors, and you will be all right.' * Instead, he will 
give pointed and minute directions regarding the daily 
details of his patient's life. Furthermore, in all proba- 



YOU AND YOUR PHYSICIAN 145 

bility, the physician will wish to keep his patient under 
continual observation, both for the purpose of himself 
studying the case closely, so that he may modify the 
regimen when circumstances dictate, and in order that 
he may make certain that his advice is carried out. Ex- 
pressed in everyday language, the physician will usually 
be found to be "strong for rest," and it is very likely 
that he will wish his patient to go to bed for a longer or 
shorter, perhaps at the beginning, indeterminate, length 
of time. If, on the contrary, he says "get out and rough 
it, ' ' or fails to lay down an itemized program, particu- 
larly as relates to rest or exercise, you will know that he 
is not the right physician. 

If in doubt as to the proper physician to consult, you 
may communicate with the secretary of the National 
Tuberculosis Association, 370 Seventh Avenue, New 
York, or put yourself in touch with the state society of 
similar title, with the state board of health (which in 
some states has a special bureau of tuberculosis) or with 
the secretary of the county medical society — any one of 
whom, if possible, will be glad to supply you with the 
names of one or more physicians having a thorough 
understanding of tuberculosis. 

A Suggestion to Those of Limited Means. In the 
event that you are unable to meet the comparatively 
higher fee of the expert, you may perhaps solve the 
problem by visiting the station of the nearest Anti-Tu- 
berculosis Society, where competent counsel may be ob- 
tained free of charge. 

The Responsibility of Relatives and Friends 

It is unfortunately true that a very large share of 

responsibility for the use of evasive and consoling terms 

must rest with the relatives and friends of the invalid, 

who have so frequently implored the doctor to hide the 
10 



146 LESSONS ON TUBERCULOSIS 

facts from the sick person. How often it is that the well- 
meaning relative has drawn the physician aside, learned 
from him the truth and then requested, "But please 
don't tell him, Doctor; it will only cause him needless 
fright and worry." 

As a rule the relative or friend has had but rudi- 
mentary understanding of tuberculosis and has failed to 
realize the great importance of the consistent and per- 
sistent application of each of the health measures. 

More : he may even try to influence the patient in ac- 
cordance with his own dim light, in a manner directly 
opposing the recommendations of the physician. As it 
is the sufferer who must bear the brunt of all mistakes, 
he has the right to receive the doctor's true opinion; if, 
then, a bad result ensues, the relative cannot be held 
to blame. Remembering the great importance of complete 
cooperation between the patient and physician, relatives 
and friends should at all times make sure that they do 
nothing and say nothing that by any possible chance 
may create the slightest misunderstanding. 

A Suggestion to Those Who Wish to Help. Here 
there comes to mind a related topic which is so im- 
portant that a moment of digression in referring to it 
may not be out of place. 

The mental side of the question of recovery is ex- 
ceedingly important, and financial worry has been one 
of the chief hindrances holding back indefinitely the 
progress of many a patient. The intense relief brought 
by the lifting of the burden of financial responsibility 
from the shoulders of the sick cannot be described ; how 
far this boosts the invalid along the route to health, 
in certain instances, is almost beyond belief. 

Only those who have felt the pinch of poverty while 
battling tuberculosis can thoroughly appreciate what it 
means to the one who is putting up the brave fight to 



YOU AND YOUR PHYSICIAN 147 

have someone step up to him and say: "My friend, you 
need concern yourself no more about finances, either for 
your family or yourself. I will look after this matter 
for you, and will see you through to the end, no matter 
how long it takes. ' ' 

On his part, the invalid should never allow false pride 
to intervene and prevent him from accepting aid from 
those able and willing to give it. On their part, the 
friends and relatives can often earn the life-long grati- 
tude of the ill person by assisting him consistently and 
at the proper time. 

Those who really wish to do everything within their 
power for those whose condition will not permit them 
to do for themselves should so plan their efforts that they 
will be most effectual. They should understand that 
the time when their assistance will do the most good 
is while the patient is still comparatively well and be- 
fore his condition becomes critical. Moreover, if their 
means permit, they should continue to extend the helping 
hand until the convalescent is able to support himself 
without endangering his health. The assistance should 
not be withdrawn when the sick person has been feeling 
and appearing well for merely a short time. It should 
be remembered that whereas outward improvement often 
comes quickly, true healing of the lungs is slow, and that 
the early appearance of health is largely superficial and 
actually marks a period of danger. If it is made neces- 
sary for the convalescing patient to jump back into work 
or in some other way to break away from the health 
program too early or too suddenly, he will be very liable 
to lose all or more than he has so far won. 

A concrete case or two may serve to make the point 
clearer : 

A young man whose personal resources were almost 
negligible but whose kin were well able to assist him, 



148 LESSONS ON TUBERCULOSIS 

was informed by a physician that he was suffering from 
advanced tuberculosis. Quite promptly the father of 
the young man paid his expenses on a trip west, and 
continued to support the son for a period of six months. 
Then, when the young man was just beginning to get on 
his feet again and was taking a new interest in life, with- 
out previous warning the father wrote, saying that he felt 
it was time for the son to begin to depend upon himself 
once more, so after another month he would send no 
more money to be spent in idleness ! Doubtless the father 
meant well, but had not the slightest understanding of 
tuberculosis, nor did he appreciate the severity of the 
blow that such an announcement would mean to the son. 
The boy died three months later. 

Another instance : A waitress in a hotel learned that 
she had been attacked by tuberculosis, but that the dis- 
ease was not advanced and that under proper conditions 
the outlook was excellent. When she stopped work and 
adopted suitable methods to reclaim her health it was 
not long until the small fund that she had been able to 
lay away was exhausted. However, there was a wealthy 
aunt who at times in the past had helped the young 
woman to weather several financial storms. This aunt 
knew of the girl's illness but thought it was foolish for 
her to give up her work, because she appeared so nearly 
well ; later, when the niece was advised to go to a sana- 
torium, the aunt felt that this was a pure money grab- 
bing scheme and, altho she assisted the girl for a while, 
she felt all the time that the money was being expended 
needlessly. The upshot of the matter was that at the 
end of three months the aunt suddenly discontinued her 
assistance altogether. 

Once more dependent entirely upon her own efforts for 
maintenance, the niec6, who at no time had seemed 
very ill and who now appeared wholly restored to health 



i 



YOU AND YOUR PHYSICIAN 149 

(tho of course she was not really well, for tuberculosis 
practically never heals within three months), found it 
necessary to resume her occupation. The sequence was 
that a year and a half later she was forced to make the 
fight all over — a fight which proved to be much harder 
than the first one. 

In conclusion, let me offer this practical suggestion 
to those friends and relatives who are financially able 
to assist. Offer your assistance early, and do not ter- 
minate it too soon. Bear in mind that the day-to-day 
worry over doubt as to one's ability to withstand the 
financial strain next month or the month after has killed 
thousands ; so if you can see your way clear at the outset 
to make it known to him who needs your assistance that 
you will continue to give it freely and fully until the 
convalescent has demonstrated degree by degree that he 
is fully able to again support himself, you will increase 
the chance for a successful outcome many fold. 

How to Help Your Physician 

While it is necessary for the physician to be frank 
with his patient, it is just as important that the patient 
be candid with his physician, so here it may be well to 
point out certain mistakes made by patients. 

Certain persons, apparently proceeding on the assump- 
tion that the physician is bent on finding tuberculosis 
at all cost, to their own detriment intentionally conceal 
facts regarding the history of their family, or concerning 
their illness — or actually lie about them. This is indeed 
a foolish mistake. The problem is often quite difficult 
even for the expert, making it necessary for him to probe 
one's family history and to ask many questions concern- 
ing the opportunities for exposure to the disease, and 
relating to one's habits, living conditions, etc. Ques- 
tions of this nature may appear trivial and uncalled for, 



150 LESSONS ON TUBERCULOSIS 

whereas they are actually in some cases of greater im- 
portance than the examination. 

Another common error made by patients is the dis- 
tortion of their financial status — the motive being the 
desire to avoid a heavy fee. Besides the fact that the 
true expert, who, usually after spending years in gen- 
eral practice, has done much extra work to fit himself 
for his specialty, is entitled to a commensurate reward 
to the extent that the circumstances of his patient per- 
mit — there is a real and decided danger in withholding 
the facts regarding one's financial resources. 

The danger is that the physician will be led to modify 
his advice to conform with what he has been told about 
the size of one's pocket book. Out of consideration for 
the feelings of the afflicted person, the physician sees no 
good in giving instructions that he knows, or thinks he 
knows, in advance cannot be carried out, and which 
under these circumstances will only cause needless worry 
and indirectly work harm. Accordingly, the doctor feels 
called upon to modify his advice, and for this reason 
often cuts down on items of the treatment which the pa- 
tient has great need of. 

A mistake made by men of large affairs is that of im- 
pressing on the doctor that they must continue on the 
job. Directly or indirectly the physician is given to 
understand that the big man cannot give a long period 
to recovering his health. The physician is perhaps told 
in advance that a definite time limit must be set. In 
some instances he is led to believe that the business man 
cannot give up his work entirely even for a short time. 

Doctors are but human, and when such limitations are 
made it is fairly commonly the case for the doctor to 
curtail the program considerably below the safety limit, 
or to fail to insist that the patient adhere rigidly to the 
schedule which the physician knows in his heart to be 



YOU AND YOUR PHYSICIAN 

best. Later, solely for this reason the rich man often 
reaps the harvest of failure. 

In this connection it is sometimes said that 
class victim of tuberculosis has the greatest 
cause the rich man will not, and the poor n 
put into effect the regimen that is necessary, 
years, thanks to the springing up of many 
table or entirely free sanatoria for tuberculos 
dispensaries, the poor man's chance has been im- 

proved ; but the obstinacy or health blindness 
man still results in many unnecessary failures T1 a slip- 
shod methods often pursued by men high in tlv: • 
walks of life in regard to their health, woulr K>t ior e 
moment be tolerated by them if followed by c . ; f ' 
employees in a business way. 

"0, if I Had Only Taken to Heart the Dc 
vice!" Again, there are those who, governor periiaps 
by the importunities of their friends, or, giving way to 
their own inclinations, perhaps feeling that th tan 

exaggerates the seriousness of the case and 1 
needlessly hampering their freedom — fall int i the 1 
of continually begging the physician for addit 
ties — repeatedly asking for permission to do t 
the other thing — matters which have already \ 
them. Even the best of physicians, after la 
well planned program for his patient, may a 
to this continual plaguing. 

Each point yielded by the physician is usug • 
lost by the patient, but he looks upon it as a pc 
altho his respect for the physician and his f uti 
ness to abide by the physician's recommence ions 
lessened' to just the corresponding degree. 

Do I hear someone say: "Having once made a set of 
rules, the doctor should hold his patient f to 

them?" In some cases this may be best, i] iers it 



152 LESSONS ON TUBERCULOSIS 

ter for the doctor to yield a point rather than 
atient fret over the matter and waste needless 
:king himself into a state of turmoil ; for thus 
be led on into casting aside all care and wander- 
ing y out of the physician's control. 

ns as a rule are anxious to respond to all 

requests, but the patient will help matters 

he will try to render himself content and make 

nd to settle down within the necessary limita- 

is he can do, if he will only try hard enough. 

ere is another type of patient who, knowing 

full well that his physician does not want him to do 

ings that he is doing, persists in doing the 

harm lings merely because the physician has omitted 

or £< en to caution against them! 

itill there are, who, apparently holding the view 
)hysician is imposing tasks upon them merely 
n of it, commit indiscretions on the sly. They 
ider that they are fooling the physician, when all 
they are hoodwinking and hurting no one but 
s. Perhaps no immediate harm ensues from 
Lhes-. e delinquencies, so the deluded sufferer is led 
nd further from the mode of living prescribed 
for him. Too late, he awakens to the realization that 
me the disease has been making a slow, creep- 
ing advance. Too late, he learns that instead of fooling 
the doctor, as he had supposed, the disease has all the 
n fooling him! 
Physicians Usually Willing to Weigh Carefully All 
v Die Suggestions. Once having chosen a physi- 
a f if it is found difficult or impracticable to follow 
some rule he has laid down, or if it is felt that under 
he cir ^instances a different plan would be better, the 
a is nearly always willing and glad to give care- 
ideration to sensible suggestions. The ultimate 






YOU AND YOUR PHYSICIAN 

decision should, however, be left to the doctor, 
physician may occasionally overlook some poin 
have a contrary bearing in the given case, 1 
majority of instances his judgment will be so 
it be remembered, too, that it is the sum oi 
fluences which turns the scales ; that one harm 
alone, one occasional slight mistake, is relath 
portant. So, when little differences arise, if a 
change of views the physician fails to see the 
the same light as the sick person, it is better for the lat 
to proceed in the way the physician has oui % ' 
try to forget their differences, than to worry c< 
over the little uncorrected errors, 

A Final Word. It is self-evident that sn 
will be derived from the counsel of the phy 
matter how competent, if one is working at odd* 
the greater part of the time. As just pointer ~>ut, ' 
invalid should do his utmost to put himself in ^nnony 
with his physician. But if, after fair trial, i1 
impossible for the two to keep in tune, it will 
prove best to break off the relationship entire 
seek advice from some physician in whom com 
fidence will be placed and with whom cooper 
prove pleasant and profitable. 



LESSON VII 
PLANNING YOUR RECOVERY 

obable that every person whose health has been 

unci' 3d by tuberculosis has had more than one friend 

who hte uffered from the disease before him. Yet the 

y is equally strong that heretofore he has 

* for years, confidently assuming that he would 

'erhaps previously not having given the matter 

thought, when the facts are exposed he experi- 

enc )rise, depression, and even doubt. Realization 

th may come as a severe blow, and the first f eel- 

e that one's whole support has been taken from 

his feeling is natural enough, it is entirely un- 
cali<- . Knowledge of the condition makes it no worse 

re : a mere name changes nothing. The outlook 
.: y the more hopeful; because one is now in 

o put up a successful fight, just as thousands 
ady done. 

The Importance op Seizing the Psychological 
Moment 

On d covery of the facts, there are some who are 

unconvi 3ed that their condition is serious enough to de- 

ention ; and so go their ordinary ways until it 

>s too late. Others, stubbornly refusing to ac- 

inevitable, likewise persist in their accustomed 

•f life, and let slip the opportune moment for ob- 

with relative ease, a complete cure without 

154 



PLANNING YOUR RECOVERY 155 

permanent crippling. So, it is often only too true that 
those who can recover, will not ; those who would recover, 
cannot. Therefore, before electing to wait in watchful 
expectancy one should realize that if this course is fol- 
lowed, later a ransom for the return of health far beyond 
one 's ability to pay may be demanded. 

The Sufferer No Longer Considered an Outcast. In 
certain circles the old feeling still prevails that he who 
is seeking to redeem his health, in order to safeguard 
other persons, must become a sort of exile, isolating 
himself almost completely from friends and family. This 
belief, which has a tendency to cause disheartenment at 
the outset, is based on misapprehension. The facts are 
these : Altho the careless victim of tuberculosis definitely 
and decidedly endangers those around him, the sick per- 
son who is careful is not a menace to others. Neverthe- 
less, the serious prosecution of health in the open air, 
especially during cold weather, does entail a certain 
amount of separation from former companions ; but this 
is merely a distasteful necessity — not ostracism. Hence, 
because the conscientious patient is a safe associate, there 
is no occasion for him to feel that he is a " leper' f and 
to avoid companionship. 

The Sensible Attitude. He who calmly faces the 
facts, who appreciates that the disease is serious but 
who also understands that under proper conditions it 
is curable, who, undaunted, at all times looks forward 
with confidence toward victory, will strongly insure his 
chances for success. 

A cheerful, optimistic disposition is a valuable asset, 
provided extreme optimism does not lead to disregard 
for the essential rules. Make up your mind, therefore, 
that you are going to win. Put aside the feeling that 
the odds are so great that you are bound to lose. Re- 
member, no matter how serious your condition, how 



156 LESSONS ON TUBERCULOSIS 

black the future seems, others just as ill as you have 
faced as great or greater difficulties — have made the up- 
hill fight — yet in the end have won. Try hard enough, 
and you will probably become convinced that you, too, 
will succeed. 

If you are by nature pessimistic, by persistently exer- 
cising your will power you may be able to change your 
views. A will to get well, and the fighting spirit, coupled 
with a knowledge of the rules of the game and the will- 
ingness to abide by them, have saved many in a so-called 
hopeless condition. 

Remember, also, that the more extensive a physician's 
experience, the less often he says that a case is hopeless 
or sets a limit to the time the sick person may live. 
Many are they who, sentenced to the grave in six months 
or so, by clinging to the doctrine " while there's life, 
there's hope" have pulled themselves back from the edge 
of the abyss and lived to help bury those who pronounced 
sentence upon them. 

Tet if, after all, you continue to look at things through 
a dark glass, you need not feel alarmed over the matter ; 
for experience has again and again proven that many 
a despondent, despairing soul, knowing "full well that 
recovery is impossible,' ' has recovered despite these dis- 
mal forebodings. 

The Future Rests Largely in Your Own Hands. In 
no other disease does the future depend so largely on 
the individual himself. One should be prepared to meet 
temptations and distractions on every side ; then, if they 
do not appear, so much the better. A dogged spirit of 
determination to make all things conform to the single 
aim is of very great advantage. The sick person should 
make up his mind once and for all to steer an unwavering 
course, always straight ahead toward the beacon light — 
health ; that he will not allow his better judgment to be 



PLANNING YOUR RECOVERY 157 

swayed by giving undue heed to the widely varying ad- 
vice which will probably be offered by f rieiads met with 
on either hand. Let it not be forgotten that well-mean- 
ing friends are responsible for thousands of deaths 
annually, and that it is just "when a feller needs a 
friend' ' most, that it is ofttimes impossible for him 
to rely upon them. If you have had the good fortune 
to have the real nature of your ailment determined while 
yet early, in all likelihood many of your dearest friends 
will insist that there is nothing seriously wrong with you, 
telling you time and again that you are wasting your 
opportunities. Unless you are quite evidently sick, do 
not expect much sympathy in your efforts to better your 
condition. Be prepared to hear folks say: "He's just a 
hypochondriac ; of late he has developed into a regular 
loafer," — "He certainly does like to take it easy," — and 
many other things along the same order. 

In your own hand rests the pen that may write 
either your death warrant, or sign your emancipation 
proclamation. 

"Patent" Medicines and Vaunted "Cubes" 

Why You Should Avoid Them. Many so-called 
"cures" for tuberculosis — some of them advertised 
nostrums, others home medicines — f or which remarkable 
results are claimed, will very likely be offered to you. 
Before deciding on taking such or such a remedy, it will 
be well to thoroughly weigh the fact that in the ma- 
jority of cases the course of tuberculosis is irregular and 
accompanied by many periods of ups and downs. If a 
certain remedial agency is first taken or applied while 
the patient is on the down grade, and improvement fol- 
lows, it is natural to give the new medicament or measure 
the credit. On the other hand, should the administration 
of the new remedy be begun while the sick person is in 



158 LESSONS ON TUBERCULOSIS 

fairly good condition, and he then grows worse, the 
tendency is to blame the remedy. Yet if a thorough- 
going investigation is made, it will be found in both 
instances that there is often no relation between the sup- 
posed cause and the supposed effect. 

At the outset it should be understood that both im- 
provement and little relapses are to be looked for, irre- 
spective of any treatment, and regardless of whether or 
not the ultimate result is good or bad; if then, the ex- 
pected upsets do not come, so much the better. It should 
be remembered further that these ups and downs can be 
altered by treatment only to a limited extent. If it is 
realized beforehand that many of these little ups and 
downs are necessary accompaniments of the working out 
or healing of the disease ; that they are mere rough places 
on the road which will eventually lead the traveler 
onward to the destination of health — he will not feel 
greatly concerned merely because for a short time he 
seems worse, nor will he fall into the error of discarding 
some valuable measure solely because its use is followed 
temporarily by an increase in symptoms. 

Why Testimonials Are Unreliable. The plain fact is 
that the tendency of the mind to link improvement — im- 
provement which may in fact be spontaneous — definitely 
to an ostensible cause, to the medicine that has just been 
taken, is the explanation of the numerous, honest but 
nevertheless untrustworthy, testimonials concerning the 
supposed virtues of many a worthless remedy. In other 
cases the feeling of faith, or at least hope, with which 
the new medicament is taken up, helps to brace the suf- 
ferer, and indirectly to actually produce a turn for the 
better (just as homesickness and despondency may, on 
the contrary, produce a turn for the worse) — this pe- 
culiar trend of circumstances accounting in another way 
for the apparently marvelous benefit derived from the 
use of some of these ready-made "cures." 



PLANNING YOUR RECOVERY 159 

Where the Facts Regarding " Patent' ' Medicines 
May Be Obtained. The flat statement may be made 
that there is today no remedy that alone cures tubercu- 
losis. It is rarely advisable to spend money on advertised 
remedies, especially on those for which highly colored 
claims are made. Certainly this should never be done on 
one's own responsibility. If you are contemplating the 
use of one of these hand-me-down "cures," you would 
do well first to write the United States Government, 
which has investigated many of them, or to the Ameri- 
can Medical Association, 535 Dearborn Street, Chicago, 
for their conclusions. 

Altho the claim is commonly made that many of these 
widely heralded "panaceas" are new discoveries un- 
known to physicians in general, the truth is that the 
active ingredients of practically all of them have on 
analysis been shown to be well-known agents, either long 
in use by the medical profession or tried and found want- 
ing and discarded as worthless years ago. Many of 
them are "shot-gun" mixtures containing many in- 
gredients put together with the hope that one of them 
may perchance hit a mark — that is, relieve some symp- 
tom. The other constituents may not be needed in a 
given case, and may even do direct harm. The most that 
can be said of the best of these ofttimes extravagantly 
praised remedies, is that it may serve to alleviate the 
cough or to bring about amelioration of some other symp- 
tom; whereas the same symptoms can in all likelihood 
be relieved in a more effective manner by the physician 
in charge, who can fit his treatment accurately to the 
concrete case. 

At All Events, Be on Guard Against Neglecting the 
Essentials. The worst feature of the patent medicine 
habit is that the sick person may learn to depend so 
fully upon the particular remedy he is taking that he 



160 LESSONS ON TUBERCULOSIS 

will be led to neglect the really essential features of the 
health program. For this reason, if you will use one of 
these remedies — be it a home remedy or one of the ad- 
vertised nostrums — above all, you should make absolutely 
certain that the spending of money in this manner does 
not make it incumbent upon you to pare closely the 
primary measures ; make sure, therefore, that you carry 
out unfalteringly the schedule for recovery you have 
laid down for yourself. 

Methods op Treatment 

In order that one may build one's plans for the future 
intelligently, it seems well to consider for a moment the 
principal remedial agencies worthy of use in tubercu- 
losis. Inasmuch as no remedy that will promptly cut 
short this disease has been perfected, the fight against 
it must for the present continue to be an indirect one, 
in which measures that serve to build up the vital power 
of the body so that the soil is rendered unfit for the 
growth of the germs, occupy first place. Remember- 
ing that an improper or unhygienic mode of life, plus 
certain other influences that undermine the vitality, are 
the main background causes that permit the seeds of tu- 
berculosis to develop, measures capable of opposing these 
vitality-sapping factors at once suggest themselves as 
effective weapons. Recalling that wrong living is the 
outstanding cause, and continuing the same line of 
thought, one quite naturally assumes that right living 
would furnish the antidote. So it has proven; for to 
the present day, right living constitutes not only the 
strongest bulwark for forestalling the onset of tuber- 
culosis, but at the same time it is the most powerful 
weapon in the fight for overthrowing the malady. 

That one may not be misled, before passing on it 
should be understood that altho right living is the key 



PLANNING YOUR RECOVERY 161 

to both prevention and cure, the significance of the word 
is not the same in the two instances. Let lis see now 
what the term, right living, means, as applied to re- 
covery. 

The A-B-C's of Recovery — Nature's Remedies. Put 
into service against tuberculosis, right living signifies 
that there should be obtained in appropriate amount: 
(1) rest, both mental and physical, (2) proper and suf- 
ficient food, (3) that one live in the fresh air, (4) in 
a suitable environment, and, if practicable, (5) in a 
favorable climate. In addition, one should endeavor to 
avoid all complicating ailments — ailments which are but 
too liable to heap fuel on fire. 

Looked at from another viewpoint, the aim is to save 
energy in every way possible and, when necessary, to 
supply the body with additional energy ; and to support 
and guide and so direct Nature's efforts that they are 
kept constantly concentrated against the disease. 

Tho the Remedies Are Simple the Dose Must Fit the 
Needs of Each Person. Thus roughly sketched, you 
have in hand the essence of success ; it is for your physi- 
cian or yourself to supply the details to fit your own 
case. 

Because the measures useful against tuberculosis are 
for the greater part so simple and commonplace, a quite 
general opinion is in circulation that one need give little 
or no study to the matter before attempting to apply 
them in one's own case. This is a serious error, which 
has led again and again to mishap. Tho the remedies be 
simple, it is of the utmost importance that they be ap- 
plied with discernment, and that the dose be gaged to 
meet the requirements of each person. 

Error to Attempt to Follow in the Footsteps of 

Others Who Have Recovered with Little Effort. The 

fact that some persons have obtained a renewed and 
li 



162 LESSONS ON TUBERCULOSIS 

firm grip on life, tho making little or no change in their 
habits of living, has done harm. While, expressed in 
percentage, the number who have recovered in this man- 
ner is small, it is true that here and there one who has 
suffered from even quite advanced disease has obtained 
complete and permanent victory, with little or no effort. 
Those who have thus recovered at small cost to them- 
selves often do much damage by advising others to fol- 
low a similar plan — a plan which in the great majority 
of instances leads only to failure. 

Here then, a cautioning word seems timely against be- 
lieving that you can do and can stand what another 
individual withstands, merely because you are appar- 
ently in the same condition. It is essential that you keep 
to your limit. The true guide is the way in which you, 
yourself, react to each undertaking. In passing, it may 
well be urged that this rule be incorporated into your 
tenets of health throughout life. 

A Competent Physician a Valuable Asset 

It is but reasonable to suppose that a physician who 
has guided others past the quicksands of deception and 
led them on to victory will be of great help to you. Such 
a physician can best analyze your case and decide on 
the precise dose of each remedy — be it Nature's remedy 
or an actual medicine — which should be administered. 
Whether or not you will require medicine, in the every- 
day use of the word, may be left for him to determine. 
(The probability is, however, that some medicine will 
be required for one purpose or another during some part 
of the treatment ; and it should be understood that the 
appropriate medicine, used at the right time as a supple- 
ment to Nature's efforts, often proves life-saving.) 
Under ordinary circumstances the health plans will of 
course be worked out in conjunction with your physi- 



PLANNING YOUR RECOVERY 163 

cian, but if it is absolutely necessary to do your planning 
without assistance it is believed that in the following 
pages you will find satisfactory outlines for your 
guidance. 

How to Frame the Program for Your Future 

Acknowledging at once that one's condition is seri- 
ous, one should set about the redemption of health in the 
same business-like manner that would be devoted to 
everyday affairs. At the outset it is highly desirable 
that a definite plan of campaign be mapped out — a plan 
that can be carried out without interruption to its ulti- 
mate conclusion. 

As a preface to laying out his plans, it is advisable for 
the sick person to make a careful census of his finances ; 
his temperament ; the exact condition of his health ; and 
of all other influences that may by any possibility have a 
bearing on the decision. While all unnecessary delay 
should be avoided, a short time given at the beginning to 
carefully threshing out each question, is not to be looked 
upon as wasted, provided the result is the formulation 
of a workable policy which one will pursue to the end. 

False Economy to Use Half-way Measures.* If you 
wish to make sure that your application for health will 
be honored, do not go about the matter in a half-hearted 
way. Nowadays, since tuberculosis is known to be less 
often fatal than was formerly supposed, it is common 
for the sick person to remain at home and to carry on 
at least a part of his ordinary business affairs at the 
same time that he is seeking health. Usually only a 
half success is to be expected from these rather half- 



* This does not mean that every case requires measures of 
the same degree. For example, if the condition of the patient 
calls for absolute rest in bed, it would be worse than a waste of 
time to attempt to make a short cut by resting- only a little. 
Conversely, if the condition is not sufficiently serious to require 
continuous rest, then the sufferer will best serve his interests 
by resting only so much as his case demands. 



164 LESSONS ON TUBERCULOSIS 

hearted efforts. Altho half-way measures are quite 
commonly of some benefit (tho but temporary, as a rule) 
and in more rare instances lead to a complete rejuvena- 
tion, it is unwise to cut down on any part of the treat- 
ment unless this course becomes imperative. When 
dealing with a disease in which, no matter how slightly 
ill one may be at the outset, there is no way of accurately 
foretelling whether victory will come easily or only after 
a hard fight, is it not logical to apply every useful 
weapon in each case? (Those who suffer from early 
tuberculosis and who are unconvinced of the necessity 
for such steps, if they have not already read Lessons I 
and V, are advised to do so now.) 

On Making a Sacrifice and Arranging Your Af- 
fairs. Sacrifices of some nature are usually necessary. 
If these relinquishments are postponed from day to day, 
in all likelihood the giving up will grow correspond- 
ingly more and more difficult. The best plan, then, is 
to make the sacrifice promptly — to take the plunge and 
have the matter over with and out of mind. A sick 
man is at best a poor workman ; is it not then both an 
economy of finance and health to drop everything else, 
if practicable, to the end that health and efficiency may 
be regained in the shortest time possible? Of course 
you wish to make the first fight the final one. So make 
every reasonable effort to lay all else aside and to put 
your affairs in order so that while " taking the cure" 
you will have no other interests to distract your atten- 
tion and perhaps wreck the whole undertaking. 

A Suggestion to Those of Limited Means. At this 
point a word of encouragement to those who feel that 
they are handicapped by a slender pocketbook may not 
be amiss. If it is impossible for one to adhere strictly 
to the rules, it should by no means be concluded that for 
this reason all chances are lost; what should be done 



PLANNING TOUR RECOVERY 165 

in this case is to follow the schedule as closely as prac- 
ticable and remember that a little more perseverance 
(especially if combined with pluck) may make up for a 
moderate laxness in following the routine. 

Then, too, persons thus unfortunately situated may 
console themselves by bearing in mind that they have 
one advantage over the other fellow — the advantage of 
having lost their health while living under very poor 
conditions. Thus, whatever slight changes they are able 
to make in the daily conduct of their lives is by com- 
parison quite large, and for this reason more likely to 
be sufficient. By way of illustration, it may be recorded 
that the observation has been repeatedly made that those 
whose health has broken down while living in crowded 
tenement districts, by merely obtaining good food and 
a moderate amount of sunshine, of fresh air and of rela- 
tive rest, can often achieve a most happy result. There 
are also free or semi-charitable institutions open to the 
needy, or, in many communities, they may obtain com- 
petent medical advice at one of the anti-tuberculosis 
dispensaries ; again, perhaps, they may avail themselves, 
gratis, of the services of a nurse skilled in treating tu- 
berculosis. (The National Association for Tuberculosis, 
370 Seventh Ave., New York, issues some very helpful 
publications listing and briefly describing the institutions 
and dispensaries for tuberculosis, both public and pri- 
vate, in the United States and Canada.) False pride 
should never be allowed to keep one from making the 
most of these opportunities. 

The Relative Importance of the Health Measures 

Notwithstanding that one may wish otherwise, cir- 
cumstances over which one has no control sometimes 
make the cutting down on some phase of the treatment 
necessary. When this is true, it is essential that one 



166 LESSONS ON TUBERCULOSIS 

have some knowledge of the relative value of each phase 
of the health regimen, in order that it may be made cer- 
tain that the sacrifice is made on one of the less important 
items. 

First and foremost, understand that only as a last 
resort, or when very extraordinary conditions arise, 
should one curtail the amount of rest taken. Neverthe- 
less, in rare instances it may be advisable to reduce very 
slightly the amount of rest, provided that in this way a 
considerable amount of time may be added to the period 
given for recovery, or if one may be enabled to procure an 
adequate quantity of good food which otherwise would 
be unobtainable. Under exceptional circumstances of 
this nature, if the patient will spend his time in sitting, 
and lie down whenever possible, this may be the lesser 
evil, and in the end prove a winning program. Even 
so, this plan is preferably avoided unless the sufferer is 
only slightly ill. 

As has just been intimated, too strong emphasis can- 
not be placed upon the necessity of making provision 
for obtaining a sufficient quantity of wholesome food. 
(This does not mean that the patient must ' 'stuff' ' 
himself — see Lesson X.) Food is to be regarded as one 
of the prime essentials. In addition, of course, it is 
highly important that one obtain at all times one's due 
share of fresh air, but as there is seldom occasion for 
anyone, anywhere, to be miserly in the use of this free 
remedy, the necessity almost never comes for cutting 
down on this important item. 

The Influence op Environment 

The importance of a suitable environment for "taking 
the cure" cannot be dwelt upon too often. Let it be 
added, however, that conditions exactly suited to one 
person may prove intolerable and wholly unfavorable for 



PLANNING YOUR RECOVERY 167 

another. On the whole, the best place for each individual 
is the place that makes it easiest for him to get com- 
pletely away from the old and faulty ruts of living ; and 
that makes it easy and natural to fall into healthful 
habits. For the majority, in my estimation, this re- 
quires a wholly new mental atmosphere — an absolute 
break in the old associations, this in turn requiring an 
entire change of surroundings. In other words, I be- 
lieve that most patients will fare better away from the 
old home, in some new environment where the surround- 
ings are congenial and pleasant; where, away from 
temptation and distraction, one's neighbors and friends 
are probably more fully informed on tuberculosis, so 
that it becomes easier for one to do the right thing. 
For this reason, irrespective of the value of climate 
(climate itself being briefly discussed a little later in 
this lesson, and fully in Lesson XII) , I believe that many 
patients will best serve themselves by moving to some of 
the better known health resorts. 

As noted above, of late there has been a growing 
tendency for the invalid to remain at home while seek- 
ing health — despite the fact that the home may be lo- 
cated among very poor surroundings in a crowded city. 
For some, of course, home treatment is best, but for 
others it has been the direct cause of failure. So, unless 
there is good reason for doing otherwise, I feel that in 
most cases the sick person will materially add to his 
chances by seeking a wholly new environment. 

Will You Go to a Sanatorium? Experiences have 
proven that in many cases it is impossible for the sick 
person to obtain satisfactory conditions either at home 
or elsewhere outside of a sanatorium. When this is 
true, one of the many well-conducted institutions for 
the exclusive treatment of tuberculosis and kindred in- 
fections may prove a most precious boon* 



168 LESSONS ON TUBERCULOSIS 

Fears That Are Ofttimes Groundless. If it seems 
best to make a sanatorium one's temporary home, one 
need have small fear of failing to find contentment 
therein. On the contrary, it is usually found that the 
relief from the cares and anxieties of the household, the 
complete release from the worries of business, and the 
privilege of securing what are perhaps the first moments 
of complete relaxation that have been enjoyed for years, 
as one sinks back on a soft bed and resigns oneself to 
letting others do the work — serve to create a totally un- 
expected and most gratifying feeling of utter content- 
ment. Here it will be found that each part of the day 
is taken up by some feature of a well-thought-out pro- 
gram, designed to prevent time from dragging on the 
hands — with the spirit of which one readily falls into 
line. 

Members of the frail sex who shrink from taking up 
their abode in an institution should give heed to the 
fact that it has again and again been proven that women 
especially are likely to find peace of mind and solace in 
a sanatorium. 

Again, there are those who fear that they will be 
brought into contact with others more ill than them- 
selves, and that this will not only prove disagreeable but 
will distinctly endanger them. This feeling, too, is en- 
tirely uncalled for ; as a matter of fact, the invalid just 
coming into a sanatorium is as a rule rather astonished 
to find that most of the patients seem apparently well. 
At all events, the very sick ones are separated from the 
others and are in bed, so that ordinarily one does not 
become intimate with them until they, too, have taken 
on at least an appearance of health. Far from being a 
place where one is liable to contract the disease or to 
add to one's trouble, experience has again and again 
demonstrated that the sanatorium is the safest place one 
can be. 



PLANNING YOUR RECOVERY 169 

Even a Short Stay May Prove Helpful. Altho a 
brief residence in a sanatorium is worth little for per- 
manency of health so far as the results obtained dur- 
ing the period spent in the institution is concerned, yet 
even when the environment elsewhere is entirely satis- 
factory, a visit to an institution of this kind, for even 
a short time, is usually of inestimable benefit in an in- 
direct manner. In the sanatorium the sick person will, 
at least, learn fairly well how to care for himself, after 
which he may, if necessary, carry on the treatment in 
some other place. 

A Resolution to Make. Whether the sojourn is long 
or short, it should be understood that full cure is not 
obtained until some time afterward. So those who "take 
the cure" in sanatoria will do well to form the firm 
resolution that they will give their full cooperation when 
the period for exercise and building up arrives, and that 
they will make the most of every opportunity for pre- 
paring themselves to cope with the living and working 
conditions that will be met with on taking their de- 
parture. 

The Sanatorium Not Suitable for All. When, how- 
ever, all has been said in favor of the sanatorium, the 
fact remains that for a certain number it fails entirely 
to provide the right environment. Some there are who 
have a fixed abhorrence for an institution of this char- 
acter, and while within its portals continually fret and 
worry and make trouble for themselves and others. If 
such persons can find an agreeable environment else- 
where, the probability is large that they will fare bet- 
ter away from the sanatorium. Other objections that 
a PPly in certain cases could be mentioned, but this will 
suffice to show that the sanatorium is not suitable for 
all, and that the temperament and other factors must be 
reckoned with before arriving at a decision. 



170 LESSONS ON TUBERCULOSIS 

A Pinal Word on Choosing the Place for " Taking 
the Cure." Everyone knows what an immense in- 
fluence for good or bad our state of mind has on each 
and every one of us. Who is there who does not recall 
the " all-in feeling/ ' the "don't-care attitude/' the loss 
of appetite, the poor digestion and the sleepless nights — 
that result from great grief, fright, homesickness, or 
some other intensely depressing emotional influence ? On 
the other hand, what a charm have faith, hope, love, joy 
and contentment, in rekindling the fires of life, strength 
and happiness ! These are all matters of common knowl- 
edge. During sickness it is but natural that the effect 
of our mental processes, in one direction or the other, will 
be even more decisive. Remembering, then, how im- 
portant it is to keep the mind in as continual a state 
of cheer and uplift as possible, so that whatever power it 
has to rule the body will be helpfully exercised, the 
endeavor should be to carry out this principle in choos- 
ing the place where one is to sojourn for health recon- 
struction. 

The Question op Climate 

Climate is to be looked upon as a valuable adjunct 
to recovery, but as less essential than rest, food, fresh 
air, and the element of time. Again, it is far more im- 
portant that the sufferer carry out the health program in 
a suitable environment, than it is that he seek the bene- 
fit of a favorable climate. Likewise, the counsel of a 
physician who fully understands tuberculosis will be 
worth a great deal more than will the mere fact that the 
invalid takes up his residence in one of the "good" 
climates. Expressed in a word, each of these things 
contributes its share toward right living, and it should 
be remembered that, as the saying runs, "How one lives 
is more important than where one lives." 



PLANNING YOUR RECOVERY 171 

Still, if one can apply every measure that offers bene- 
fit, including climate, so much the better. So, as some 
change of residence is usually desirable in order to afford 
a freshness of surroundings, and since it is usually much 
easier to carry out the health program where others are 
doing likewise, in making the change of residence (unless 
there be some sound objection to this plan) why not 
move to a health resort in a more favorable climate — 
thus adding one more building stone to your house of 
health ? In this connection it is well to remember, also, 
that many will not adhere to the rest-fresh-air program 
in a cold, disagreeable climate, yet will do so in a warmer 
climate. As faithful and prolonged observance of the 
health regimen is of prime importance, the decision for 
or against a change of climate may in some cases hinge 
on this point. Other items weighing for or against 
climatic change will be mentioned in Lesson XII. 

Time the True Healer 

It is impossible to accentuate too strongly the im- 
portance of the role of time. Altho when feasible it is 
desirable to make use of all measures and means at one's 
command, it is just as imperative that a plan be adopted 
which can be carried out for an adequate length of time. 
That one may not experience the keen feeling of dis- 
appointment and disheartenment that a relapse would 
bring, it should be understood that even tho the disease 
is still in the so-called incipient stage, lasting results 
can seldom be obtained in less than six months, and a 
longer period will often be found necessary. Those suf- 
fering from more advanced disease will probably require 
a year or two, and, not uncommonly, several years, if 
the malady is to be forever conquered. In the past 
the mistake was often made of advising patients of scanty 
means to make a long trip for climatic benefit, or of 



172 LESSONS ON TUBERCULOSIS 

counseling them to enter some expensive institution — 
procedures that produced so heavy a drain on the 
finances that it was often necessary for them suddenly 
to cut short their stay or to skimp on other essential 
items. 

"How Long Will It Take, Doctor?' ' In the pre- 
ceding lesson it has been shown how, in former years 
especially, certain physicians have been led to under- 
estimate the time necessary for complete recuperation, 
and have unwittingly given their patients erroneous 
and wholly misleading answers when asked the ques- 
tion, "How long do you think it will take, Doctor t" 
Placing complete reliance in the doctor's advice and 
taking the arbitrary time allowance he had set at its 
face value, the patient laid his plans accordingly. With 
the elapse of time, when the period allotted to recov- 
ery had ended, irrespective of whether his condition on 
that date was good or bad, he was forced to break off 
the routine prematurely and rather suddenly, and to 
fall back into the old rut of living. 

What was the result ? Too often it was a relapse — 
perhaps even irretrievable failure. 

Well to Avoid Setting a Fixed Limit. Many and 
many who could have won, have lost — simply because 
they discontinued their efforts too soon. With this fact 
etched in the memory, and remembering also that when 
a time estimate is given by a most expert physician, even 
then circumstances may arise that will make necessary 
the lengthening of the time allowance, one will do well 
to avoid fixing any set limit to the period allotted to 
recovery. 

After the earlier steps in the treatment have been 
carried out sufficiently long to bring the sick person back 
to apparent health, it is even then advisable for him to 
defer all work for several months or longer — perhaps 



PLANNING YOUR RECOVERY 173 

for a year or more — during which he builds himself 
up into as fit a condition as possible (see Lesson IX). 
Later, when he actually gets back into the harness, what- 
ever work is undertaken should be taken up by degrees, 
and for many years the plan of taking periodical vaca- 
tions at frequent intervals should be religiously observed. 
If this procedure is followed, the percentage of per- 
manent results will be high. 

A Final "Word: First and last — make it a point to 
see that you do not short-measure yourself on this 
cheap yet priceless element.* 



* Only those who have watched a large number of patients 
make the fight against tuberculosis can really appreciate the vital 
importance of the time factor. How often have I seen patients 
who, on learning that they have tuberculosis, hurriedly, almost 
frantically, take up the fight, which they wage with intense vigor 
until they have taken on an appearance of health and are on the 
verge of again coming into their own. Then, believing victory 
assured, they cease their efforts and go along in indifferent 
fashion until time brings a relapse. Again the fight is taken up 
in hit or miss fashion and waged hysterically for a short period. 
Once more the relapse comes; once more the fight is resumed — 
only to be dropped again just as victory comes barely within 
sight. And so their efforts are continued indefinitely — efforts 
which in the end prove wholly fruitless. Such persons, and there 
are many of them, are convinced that tuberculosis is incurable 
because they have not learned the lesson that only by the con- 
tinuous prosecution of a well-thought-out plan of campaign over a 
long period of time can one obtain assurance of a real and lasting 
victory. 



LESSON VIII 

HOW NATURE HEALS 

That one may be prepared to put up a winning fight, 
it is necessary for it to be understood that the mode of 
healing in tuberculosis is quite different from the man- 
ner of healing of many other diseases. For instance, 
as a result of a successful battle against scarlet fever 
or smallpox, all the germs within the body are de- 
stroyed; thenceforward, the individual enjoys almost 
complete freedom from liability to another attack. On 
the contrary, after recovery from an outbreak of tu- 
berculosis, provided the mode of life is unchanged, on 
the average, one is more liable than ever to break down 
with tuberculosis. 

The reason for this is that in many cases healing is 
not accompanied by the destruction of all the germs 
of the disease. Many of the germs are killed, but others 
are merely imprisoned within the body, where they may 
linger for a long time, perhaps during the rest of life. 
Thus, altho the individual is apparently well and vigor- 
ous, and able to take an active part in useful affairs, 
nevertheless, a repetition of the same influences that 
favored the original attack may cause another outbreak. 

A Word of Encouragement. Before proceeding fur- 
ther, it may be well to add that nothing herein is to be 
construed as meaning that tuberculosis is not really cur- 
able. Quite the contrary, the purpose of these para- 
graphs is to furnish convincing evidence that while heal- 
ing is generally a slow process, yet if patience is ex- 
ercised, one may usually look forward to a complete 

174 



HOW NATURE HEALS 175 

and lasting victory. If it is appreciated how Nature ac- 
complishes her ends, by imitating and supplementing her 
methods, and assisting her in every way possible, suc- 
cess may be insured. 

Partial Healing Often Spontaneous, but Complete 
Recovery Usually Requires Definite Effort. Quite 
curiously, tuberculosis has a tendency to heal spon- 
taneously, with absolutely no effort on the part of the 
victim. Unfortunately, however, the repair wrought in 
this manner is in the majority of cases only partial. 
Many there are, who, at one time or another during life, 
unknown to themselves have acquired at least a trace of 
tuberculosis, which later has healed completely and per- 
manently, without their having at any time become 
cognizant of the fact that their bodies provided a refuge 
for the tubercle germs. So, too, in a few instances, 
when the disease has become so pronounced as to produce 
manifest disturbances of health {evident tuberculosis), 
especially in the cases in which the malady has not pro- 
gressed beyond the so-called first or minimal stage, 
complete healing has occurred — without change in the 
mode of life, and without treatment of any nature. 

Moreover, even in far advanced cases some evidence of 
spontaneous healing is nearly always to be found. Never- 
theless, when once the malady has obtained so firm a 
grasp upon the individual as to produce noticeable in- 
fluence on the well-being, altho even then Nature makes 
an attempt at healing, as a rule she fails to complete the 
process, if unaided. In this case, likewise, a partial 
arrestment often occurs spontaneously and lasts for a 
longer or shorter period. Yet too often after a few 
months, or a year or two, of comparative health, some 
intervening factor serves to make the soil again fertile, 
or to awaken the slumbering bacilli, and a fresh break- 
down is the result. 



176 LESSONS ON TUBERCULOSIS 

Futility of Prophecy. Furthermore, even in the 
early stage, there is no way of prophesying with cer- 
tainty, in which cases the disease will, and in which it 
will not, heal of its own accord or with little effort. The 
mildest cases may develop into the worst, and vice versa. 
This merely emphasizes that in all cases full advantage 
should be taken of every weapon known to be useful 
against tuberculosis. 

Nature's Four Methods of Repair 

Briefly stated, Nature proceeds to repair the damage 
done by disease in several different ways, now to be 
described : — 

1. complete destruction op all germs; no evidence 

remaining 

The germs may be all killed and the cells composing 
the tubercle reabsorbed into the blood stream or removed 
to some other part of the body ; in this case little or no 
evidence of the germ invasion remains. Such a termina- 
tion is uncommon, and usually occurs only when a small 
area has been affected. 

2. HEALING BY SCAR FORMATION AND PLEURISY 

Scar Formation. Again some of the bacilli are 
killed, others weakened ; part of the tubercle is absorbed ; 
around and within the remaining portion Nature builds 
a restraining wall of scar (healing tissue — sometimes 
called fibrous or fibroid tissue) — thereby, as it were, 
penning up or imprisoning the germs that she has been 
unable to kill. The newly formed healing tissue is at 
first extremely delicate, and very easily destroyed; but 
as time goes on, the at first frail threads are builded 
into a firmer and firmer wall of scar. Like scars else- 
where, as they grow older, the scars built in the lungs 



HOW NATURE HEALS 177 

have a pronounced tendency to contract and to occupy 
a smaller space; but the destroyed lung substance is 
never replaced by new functioning air cells. 

Evidences of Nature's Foresight. Here, however, 
is seen another instance of Nature's beneficence. She 
has supplied the body with an overabundance of lung 
tissue; hence one may live an active, unhandicapped 
life even tho a considerable area of one or both lungs 
is put out of commission. In fact, one may live with 
only one sixth of the lung capacity remaining. Further- 
more, even tho a large part of Nature's reserve equip- 
ment of lung tissue be destroyed, there comes into play 
another favorable factor. For, while the scars are be- 
coming firmly set, other adjustments are taking place. 
For one thing, the air cells in the relatively sound por- 
tions of the lungs are enlarging (very gradually, it is 
true) — a process which enables them to do more than 
their accustomed amount of work, and to compensate to 
a considerable extent for the efficiency lost by the crip- 
pling of other parts. Meantime the heart and other 
organs are recovering from the strain imposed upon them 
and adapting themselves to the new conditions, and tak- 
ing on the additional functions made necessary by the 
shifting of their positions, etc. (soon to be described) 
incidental to the loss of a certain amount of lung tissue. 

Nature's Work Is Done Slowly. It is astonishing 
what ravages Nature will repair, if she is only given 
sufficient time. It should be understood that even in 
<early cases a year or two, or three or more years, are 
required for the scars to become thoroughly cemented 
and for the other compensatory adjustments to take 
place. During this time the convalescing patient usually 
feels so well that he is very likely to overtask himself 
and undo all the good that has previously been wrought. 
The exercise of a little patience and the willingness to 



178 LESSONS ON TUBERCULOSIS 

continue to hew closely to the line during this period, 
is often the deciding factor on which hinges the whole 
future welfare. 

Healing of the Lungs lake Healing of a Wound on 
a Tree. The scars that form in the lungs are very- 
similar to the rings of compact, hard wood often found 
surrounding nails or other foreign bodies that have be- 
come imbedded in trees. As the scars in the lungs be- 
come firmly set, they are apt to bring about peculiar 
distortions of the surrounding tissues, such as one some- 
times sees on the face of some unfortunate individual 
whose features have been disfigured by the shrinking of 
the large scar-like bands resulting from an extensive 
burn. The contraction of scars in the lungs frequently 
produces odd, star-like formations within the substance 
of these organs, and peculiar puckerings or dimples upon 
the surface. The scars may also block the entrance of 
air into nearby healthier air cells, hindering their func- 
tioning, and even causing collapse of large sections of the 
lungs. 

Owing to the fact that in health each organ of the body 
is connected at one or more points with the organs or 
parts immediately adjacent, it is obvious that small in- 
fluences may disarrange the orderly scheme whereby each 
organ fits into its own nook or corner. If one organ is 
disturbed, neighboring organs are apt to be disturbed 
also. Thus, the shortening of large masses of scar may 
make in time so strong a traction on a nearby organ that 
it is drawn into, and firmly bound down in an entirely 
new position, and the performance of its ordinary duties 
may be seriously interfered with. 

Healing by Pleurisy. At some time during the 
course of tuberculosis, the surface of the lungs (that is 
to say, the pleura — the lining covering the lungs and the 
inner surface of the chest wall) is very likely to become 



HOW NATURE HEALS 179 

inflamed. This is the more probable if the tubercles are 
located near the surface. If pleurisy occurs, the pleura 
may be simply roughened, like sandpaper ; but in other 
instances a sticky material is secreted which, here and 
there, causes the lung to adhere to surrounding parts, 
including the chest wall. In some cases the gluey sub- 
stance gradually solidifies and in turn becomes hard and 
scar like in character, so that in places the pleura is now 
covered with a dense encrustation (pleural thickening). 
Where the pleura has become adherent to other organs 
or parts, the setting of the gluey material results in the 
formation of definite bands joining the lungs to the 
adjacent tissues (pleural adhesions). By preventing 
undue expansion of the diseased areas, these adhesions 
promote local rest, and to this extent are to be looked 
upon as favorable to healing. 

Thus pleurisy is shown to be, in part at any rate, 
an indication of the effort of Nature to protect herself. 
Even the pain that quite often accompanies pleurisy, 
which is ascribable in the main to the rubbing together 
of the roughened, sand-like surfaces, seems at times to 
serve as a friendly warning against too deep breathing, 
which would interfere with Nature's repair work. 

How Nature Sometimes Overdoes Things. Now and 
then a case occurs in which as a result of pleurisy, a 
large amount of the gluey material, or a thinner liquid, 
is secreted, which to a greater or less degree fills the 
pleural space (" water on the lung" or pleural effu- 
sion). Like the dry pleurisy just described, and the 
band-like pleuritic adhesions, the fluid thus formed is 
sometimes a definite aid to the sick person. Through 
mechanically compressing the lung this organ is re- 
lieved from its accustomed round of daily duties and 
given opportunity for recuperation. In other cases, 
however, influences that are ordinarily beneficial may 
become so pronounced as to definitely hinder recovery. 



180 LESSONS ON TUBERCULOSIS 

Unfortunately, such instances are common enough 
throughout the whole range of Nature's handiwork. The 
knitting of broken bones furnishes a case in point. 
Shortly after the injury has occurred, material for re- 
pair is deposited around and between the broken bone 
ends. This new material is at first soft and jelly like, 
but gradually hardens and finally takes on the charac- 
teristics of genuine solid bone. In order to make sure 
that the supply of this repair substance (called callus) 
is ample, Nature usually manufactures more of it than is 
actually required. This surplus callus occasionally does 
harm by interfering with the action of muscles, with the 
movement of joints in the neighborhood, and so forth. 

Quite similarly, the scar-like pleuritic thickenings or 
bands sometimes prove positively detrimental, just as 
does excessive scar formation in the lungs. So, too, 
pleural fluid may develop in an unnecessarily large 
quantity, and through pressure or otherwise, produce 
decided difficulty in breathing, and other disagreeable or 
definitely hurtful effects. In such an event, the ordina- 
rily conservative process becomes an actual menace, and 
in some eases relief must be given by drawing off some of 
the fluid (tapping). 

3. HEALING BY CHALKY DEPOSIT 

In addition to building a barrier of scar around the 
germs, Nature sometimes endeavors to make their im- 
prisonment more certain by depositing in and around 
the tubercles a mortar, or lime-like substance, which 
eventually hardens into a firm, chalky or cement-like 
deposit. The so-called "lung stones," which are occa- 
sionally coughed up by patients, are really larger or 
smaller particles of this chalky deposit. These stones 
often contain live germs which are in this manner once 
and for all eliminated from the body. 



HOW NATURE HEALS 181 



HEALING BY CAVITY FORMATION 



The small or large excavations that develop in the lung 
as a result of softening of the tubercles are to be looked 
upon as a step along another route that in time leads 
to healing. When in any spot the disease has progressed 
so far that Nature is unable to kill all the germs, or to 
wholly replace the tubercles with scar, she does the next 
best thing. There is some reason to believe that at this 
stage Nature herself completes the softening of the tu- 
bercles — converting them into a semi-liquid material, 
which is passed off in the sputum. Certain it is, that 
the formation of a cavity is in many instances a step 
toward the end, the end being recovery. It will be 
seen, therefore, that while a cavity is not to be particu- 
larly desired, it is a great deal better than no healing 
at all. 

A Cavity Virtually Outside the Body. In the heal- 
ing of a cavity, scar formation again assumes a promi- 
nent role. A restraining wall of fibrous tissue, which is 
at first delicate and easily destroyed, but which in time 
becomes a compact, thick, more or less spherical ring or 
shell of scar, is degree by degree thrown up around the 
cavity. With this much of Nature's work completed, 
altho the cavity — the hole in the lung — is still in exis- 
tence, yet inasmuch as it communicates with a bronchial 
tube, for practical purposes it may be regarded as out- 
side of the body. Hence, even tho the discharge may 
continue for a long time, it finds outlet right at hand, 
and the chance that the poisonous material may leak into 
the circulation and be distributed throughout the body, is 
cut to a minimum. 

The scar around the cavity shows the same inherent 
tendency to contract that scars do elsewhere, so as time 
passes the originally large and jagged, irregular-walled 



182 LESSONS ON TUBERCULOSIS 

excavation is squeezed upon, and, as the shrinking pro- 
cess continues, if all goes well, is gradually reduced to a 
small, smooth-walled, comparatively dry cavity. As time 
proceeds, it may even become completely dry, so that the 
expectoration ceases entirely. If the cavity is small, the 
continued progressive building up of the scar tissue, fol- 
lowed by its contraction, may ultimately lead to the com- 
plete obliteration of the excavation. 

Transformation of the Cavity into a Branchial Tube. 
In still other instances, after the cavity has become 
small and dry, the mucous membrane of the neighboring 
bronchial tube may grow and spread, and, little by lit- 
tle, inch its way along, until it finally creeps into, and 
forms a lining for, the walls of the cavity. In effect, the 
cavity then becomes merely an extension of the bronchial 
tube. 

Explanation. Nothing in the foregoing paragraphs 
is intended to imply that the continuation of ex- 
pectoration necessarily means that the cavity is not 
completely healed. Altho it is unusual for complete 
healing to take place while the expectoration continues, 
yet this does occur in certain instances. In these cases 
some expectoration (which does not, however, contain 
tubercle bacilli) continues for a long period after the 
lung damage has been entirely repaired. In such in- 
stances, the expectoration may be kept up by a simple 
bronchitis — a bronchitis which was perhaps initiated by 
the continual irritation of sputum passing out over the 
delicate lining of the bronchial tubes, by frequent or 
prolonged coughing, or some similar influence. How- 
ever, if tubercle germs are found in the sputum, this 
always indicates the presence of a cavity (or an ulcera- 
tion — a saucer-shaped concavity). Nevertheless, unless 
the cavity is sufficiently large to be detected on the 
examination of the chest, or by the X-ray, it is usually 
disregarded. 



HOW NATURE HEALS 183 

Persons with a Cavity Not Necessarily Handicapped. 

H those who look upon a cavity with dread would hold 
fast to the fact that the formation of a cavity is in 
some cases the only method by which the disease may 
be eliminated, they would very likely experience a pro- 
found feeling of relief. He who has a well walled-off 
and fairly well shrunken, tho not completely dry cavity, is 
simply put to the trouble of extending slightly his morn- 
ing toilet. After a short while, one usually learns the 
trick of clearing out the discharge with very little effort, 
and with little or no cough, so the morning house-clean- 
ing becomes an easy habit. To-day, thousands of per- 
sons in just this condition are going about constantly, 
apparently well, conducting their business in a perfectly 
normal manner. Moreover, throughout the land 
there are individuals (totaling a fairly large number, 
altho only a small fraction of the whole population) in 
whom the disease has gone on to cavity formation with- 
out the true cause — tuberculosis — having been recog- 
nized.* 

Farther, those who harbor a cavity, have the satis- 
faction of looking forward to the day when the ex- 
pectoration may entirely cease and the cavity become 
forever closed. 

Why Healing Is Often Incomplete and Relapse 
Common 

Like members of the human race, Nature, too, has 
her frailties. Thus, when undertaking a task, she has 
a strange tendency to overexert herself at first and to 
do even more than is necessary ; after which, not uncom- 
monly, she early relaxes her efforts. Almost everyone 

* Some of these persons have made no definite effort to re- 
cover their health, yet at last the disease has become arrested 
spontaneously. However, these are merely the exceptions that 
prove the rule that tuberculosis demands intelligent, systematic 
and prolonged management and treatment. 



184 LESSONS ON TUBERCULOSIS 

is familiar with some example of this strange trait of 
Nature. 

Who has not at some time injured his hand and after- 
wards noted the new formed healing tissue in the 
wound — tissue built up in so large an amount that it 
actually protruded above the surface of the surrounding 
skin (proud flesh) ? Who has not helped to trim the 
useless sap-suckers from trees in the spring? These 
are but two everyday illustrations of the often prodigal, 
sometimes harmful, expenditure of Nature's energies. 
Conversely, like the racer who makes a spurt past the 
grandstand for effect on the onlookers, Nature, after 
making a preliminary good showing, has a tendency to 
lie back on the job and (seemingly thinking that in 
making a good start she has done enough) to loaf and 
let the work "go to the dogs." As will now be ex- 
plained, this very human twist in Nature's make-up 
is the cause of many of the waves of ups and downs 
that mark the course of the white plague. (In certain 
instances these oscillatory waves recur with singular 
regularity at intervals of from one to three weeks.) 

Once Nature has succeeded in building up a barrier 
of protective cells and scar around the invading germs 
(so that few germs and little poison escape into the 
circulation to keep the defensive forces of the body as a 
whole constantly aroused to fighting pitch) — it is not 
long as a rule until, consoled and misled by a false feel- 
ing of security, Nature seems to tire of the contest and 
allows her efforts to practically cease. In the mean- 
time the germs are fighting for their very existence. 
As time goes along, they multiply and their forces grow 
stronger, till eventually they may succeed in breaking 
through the restraining wall. Inasmuch as the protec- 
tive army has been in large part recalled from the seat 
of action and mustered out, the body is caught unpre- 



HOW NATURE HEALS 185 

pared, so that even tho its disintegrating forces be 
promptly rallied, the probability is strong that the 
germs will have made at least some advance before 
Nature can again gain the whip hand. In this manner, 
first one side and then the other acquires control of the 
situation — and the battle continues indefinitely. Each 
advance of the germ army corresponds to an extension 
of the disease — made evident to the sufferer by the addi- 
tion of some new symptom, or by the increase in severity 
of one or more of those from which he already suffers. 
Each time that Nature gains the mastery, the disease 
becomes quiescent, and the afflicted person enjoys a 
season of comparative health. 

Proof Furnished by Everyday Incidents. He who 
doubts that Nature is often like the dilly-dallying work- 
man may perhaps convince himself by recalling one of 
his own past experiences. If one has at any time care- 
fully observed the healing of a superficial wound caused 
by some chance accident, it has been noticed, perhaps, 
that within a few days new skin began to form around 
the edge of the wound and to creep in toward the cen- 
ter, until presently a large portion of the denuded area 
was covered. If one continued watching, one was per- 
haps surprised to find that the closure of the last 
half of the wound required twice or even three times 
as long a period as was consumed in repairing the 
first half. Yet if, as chance would have it, before the 
first wound had mended completely, one was unfortunate 
enough to have the skin scraped off the injured member 
in some neighboring spot, shortly afterward it was very 
probably noted that (in spite of the quite evident slow- 
ing up of healing in the first wound) this fresh wound 
had already begun to heal quite rapidly. 

Horticulture furnishes another convenient illustra- 
tion. If a limb be sawed off a tree or a slice taken off 



186 LESSONS ON TUBERCULOSIS 

the bark and substance of the trunk of the tree, after 
a very short interval a rounded edge of new-formed wood 
begins to grow in from the edges of the wound. For a 
time, the new wood continues to grow rapidly until a 
large portion of the defect is covered. Then, at this stage 
of healing, for apparently no reason at all, the process 
of repair slows up, and in some instances ceases alto- 
gether. Thus, altho Nature may have plenty of latent 
power, yet in the absence of a continual irritation of 
some sort to keep her energies awake, she often fails to 
make full and proper use of it. 

A Key to Treatment. These incidents are not only 
interesting, but have pointed the way toward the more 
effective treatment of the disease. The surgeon who is 
treating an indolent, sluggish wound, such as a chronic 
leg ulcer, aims to keep Nature's energies constantly ap- 
plied to the task of healing — by applying an irritant, 
such as lunar caustic, to the wound at opportune mo- 
ments. So, in tuberculosis, the skilful physician has an 
opportunity not only to assist in conserving the re- 
sources of Nature, but by suitable means he endeavors to 
support her efforts and to so direct her energies that they 
are kept always concentrated on the work in hand. (See 
discussion of tuberculin treatment in Lesson XV.) 

The Significance op " Colds' 9 in the Course op 
Tuberculosis 

In connection with the ups and downs of tuberculosis, 
there is one point not commonly understood, about which 
it seems well to say a word or two here. When the case 
is progressing favorably, altho ultimately complete vie- j 
tory probably will be won, yet in the meantime one or 
several or even many temporary upsets, which at the 
time may appear to be serious backsets, may occur. Ow- j 
ing to the fact that at these periods the cough is liable s 



HOW NATURE HEALS 187 

to be exaggerated, the expectoration freehand the fever 
higher (or perhaps one or more of these symptoms may- 
be present only at this time), the patient may feel that 
he has taken "cold." As a matter of fact, difficult as 
it may be to believe, a certain number of these flare-ups, 
resembling colds, are actually but outward evidences of 
Nature's efforts to rid the body of the disease. In other 
words, these manifestations are apt to occur at the very 
time that Nature is spurred on to a more vigorous fight. 
If the patient will look upon these occasional outbreaks 
as perhaps of beneficial nature, rather than construing 
them all as relapses; if he will bear in mind that a 
certain amount of cough and expectoration are neces- 
sary for the elimination of the germs; and that the 
fever and other symptoms are often merely inevitable 
tho disagreeable accompaniments of the process of heal- 
ing — the little inconvenience and distress experienced 
at these times will be much easier put up with. 

Ever remember that the pathway to health is by no 
means always smooth; that it may even be roughest 
of all just before the tape marking the victorious end 
of the race is crossed. 



LESSON IX 

ON REST AND EXERCISE 

Some persons still hold fast to the old belief that 
exercise is the essence of the cure for tuberculosis. 
Others are just as firmly convinced that rest is the pass- 
word that opens the gateway to health. As a matter 
of fact, as is usually the case, the middle ground is 
the safe one to tread. These two opposite agencies are 
both valuable remedies. Each fills its own place of use- 
fulness, in which neither can supplant the other. Rest, 
for repair, is needed mainly in the first half of the treat- 
ment. Exercise, for endurance, will probably be re- 
quired later. 

As the subject unfolds, we shall see just what is 
meant by each of these terms, as applied to disease of 
the lungs. 

Why Rest Is Necessary 

Rest aids recovery in two ways, both by its salutary 
effect on the body as a whole, and upon the lungs. 
During rest there is a minimum expenditure of energy, 
and the amount saved is concentrated in the fight against 
the disease. Both mental effort and physical exertion 
require an output of strength or power; so mental and 
physical rest are both important. Moreover, rest in the 
reclining position, owing to the influence of gravita- 
tion in augmenting the quantity of blood in the lungs, 
serves to bring the healing elements in larger amount 
into direct contact with the diseased tissue, in this man- 
ner promoting repair. 

188 



ON EEST AND EXERCISE 189 

Again, when one is at rest, the call on each organ for 
work is lessened; on the lungs this local effect is par- 
ticularly important. Nature's newly formed healing 
tissue is as delicate as a spider's web, and is as easily 
injured. Almost everyone has observed that the con- 
tinual scratching or irritation of a sore on the surface — 
on the arm, for example — delays healing; and has 
learned from experience that the injured member is 
made useful again much more quickly if it be given 
protection and rest. But it is not so well known that 
rest is just as good a medicine for the sick lungs. Com- 
plete rest of the lungs can of course never be obtained ; 
but when the body as a whole is at rest, the depth and 
frequency of the breathing is lessened and cough is 
diminished. Thus the new threads of healing tissue 
are protected; and the chance of spreading the disease, 
by inhalation of the germs into other areas, lessened. 

Proof That Rest Is Valuable. How many there are 
who, tho they would not think of using an automobile 
with a broken cylinder, persist in driving the human 
machine at a time when its need for rest and repair is 
equally great. It is well known that the knitting .of a 
broken arm or leg is facilitated by any means that pro- 
duces rest of the part. Moreover, tuberculosis of the 
bones and joints has long been treated by fixation in a 
plaster cast, or by some other form of immobilization. 
It is also quite generally recognized that nearly all 
other diseases are benefited by rest. Why then is not a 
similar method applicable to tuberculosis of the lungs? 

Nature herself has supplied the answer. 

Almost every case of tuberculosis presents near the 
seat of the disease some evidence of thickening of the 
pleura (the pleura is the thin glistening lining or mem- 
brane covering the lungs and the inner surface of the 
chest wall) or pleural adhesions, which bind down the 



190 LESSONS ON TUBERCULOSIS 

lung to a greater or less degree. These bands and 
thickenings restrict the motion of the diseased parts 
(as explained in Lessons IV and VIII) giving rest and 
quietude and promoting healing. 

Again, in certain cases, fluid accumulates in the 
pleural space — that is, between the lung and the chest 
wall (pleural effusion) — and compresses the lung, 
thereby in another manner limiting its expansion; the 
interesting observation having been made that this 
phenomenon is sometimes followed by more rapid healing. 
Similarly, when as a result of a certain peculiar accident 
or complication which occasionally occurs in the case of 
tuberculosis, air gains access to, and to a greater or 
less degree fills, the pleural cavity, causing collapse of 
the lung (spontaneous pneumothorax) healing is not 
uncommonly given a definite push forward. 

These illustrations and discoveries all suggest that 
rest is of value, but the final " proof of the pudding is in 
the eating": the multiplied lessons of experience justify 
the statement that rest is indeed the great restorer. 

General Instructions for Resting 

No fixed standard as to the precise amount of rest 
necessary can be given; but all persons suffering from 
active tuberculosis require some rest. On the whole, the 
amount needed is governed by the exact condition present 
in the lungs of each individual; but the state of the 
heart and other organs — each and all affected indirectly, 
to a greater or less degree, in tuberculosis — must also 
be reckoned with as controlling factors. As these mat- 
ters can be accurately determined only by a thoroughly 
competent physician, they will not be taken up in de- 
tail here, altho suggestions along this line will be given 
in a later paragraph. 

The Six-hour Man and the Sixteen-hour Man. To 



ON REST AND EXERCISE 191 

a certain extent, also, rest is a relative factor; the con- 
ditions under which the breakdown in health occurred 
having some bearing on the amount of rest needed. 
For example, an extreme case may be considered : Of two 
men ill in like degree, the one who lost his health 
while working six hours a day would probably require 
more rest than the one whose health failed while he 
was working sixteen hours a day. If the sixteen-hour 
man simply stopped work and sat around a considerable 
portion of the time, he would perhaps obtain as much 
relative rest (that is to say, as great a change from the 
conditions under which he was working at the time his 
health failed) as the six-hour man would obtain by going 
to bed. 

However, this illustration is to be interpreted as indi- 
cating that if circumstances rendering it impossible for 
one to secure complete quiet and repose arise, or if 
other important influences militate against the use of 
a large amount of rest, one may still hope for a favorable 
outcome, rather than as furnishing a definite guide to 
the precise amount of rest one should take. In other 
words, in the case cited, the probability is that the 
sixteen-hour man, too, could improve his chances still 
further by seeking absolute rest for a time. Moreover, 
if he has much cough and expectoration ; or more than, 
say, one-half or at most one degree of fever; or if he 
shows in other ways that he is materially sick; or if, 
in the absence of these factors the disease is known to 
be at all extensive ; or again, if, tho small in extent, the 
disease is progressing, unless overruled by some excep- 
tional state of affairs, rest in bed, for a short period at 
least, is almost indispensable. In such a case, whether 
or not rest in bed seems necessary for the conservation 
of general energy, it is necessary for the purpose of af- 
fording local rest — rest of the disabled organ — which is 
also highly important. 



192 LESSONS ON TUBERCULOSIS 

Rules for Rest* 

1. Rest When Fever Is Present or When the Dis- 
ease Is Progressing. When the malady is making 
headway, one should usually be at absolute or com- 
plete rest. (Definite instructions for obtaining complete 
rest will be given in a moment.) 

Ordinarily, progress of the disease is marked by fever, 
which is the most accurate single guide, from the stand- 
point of the one who is sick, at any rate. Hence, fever 
is the most frequent indication for rest. Note: One 
should not, however, make the mistake of permitting the 
presence or absence of fever to be the sole criterion. It 
is necessary for it to be thoroughly appreciated that 
in certain cases the disease may continue to make fur- 
ther and further inroads, despite the complete absence 
of fever, even as recorded by the thermometer. It is 
even true that in some cases fever may not be noticed 
throughout the entire course of the disease.t 

For this reason it is essential to remember that 
the occurrence of any other sign that the disease is 
gaining ground also calls for rest; and that some per- 
sons with a strictly normal temperature require rest 
even more urgently than others having a low or mod- 
erate fever. Ordinarily, observation combined with a 



* These rules refer to rest in bed, barring 1 certain exceptional 
circumstances, to be noted on later pages. In those not uncom- 
mon cases in which the fever recurs only at intervals, one should 
make it a point to rest when the temperature is on the up-wave. 

t (1) If the resisting forces of the body are at low ebb, there 
may be no fever, or the temperature may even be below normal, 
notwithstanding the steady onward march of the disease. Again 
(2) occasionally, if the focus of disease is well localized by a 
firm wall of scar (healing tissue), the poisons may not escape 
into the general circulation, to be distributed throughout the 
body; hence there may be no fever, altho the area involved be 
quite large and the process be at least fairly active. (3) In 
fibroid tuberculosis (described rather fully in Lesson V, p. 125) 
fever may not be detected throughout the whole course. Then too 
(4) the freedom from fever in certain cases is explained by 
the fact that the body develops a quite pronounced tolerance (a 
relative immunity) to the poisons; hence, in this case, even tho 
the poisons seep out from the seat of disease in considerable 
amount, fever may be entirely lacking. 




ON THE ROAD TO HEALTH 

Rest — usually rest in bed — is a first essential in conquering tuber-, 
culosis. Many persons are convinced that they cannot really relax and 
rest if they go to bed, and that if they "do give up" and force them- 
selves to stay in bed, they may never get up again. This patient thought 
likewise, but the picture was taken when she had been in bed seven 
months. She does not seem to have grown weaker, and notice how 
happy and contented she is. 




MAKING HASTE SLOWLY BUT SURELY 

These patients have progressed to the point where they can safely 
sit up for a few hours each day, yet unwise undertakings could easily 
undo all they have gained. They are enjoying life and feel able to do 
considerably more than they are allowed, but are willing to make haste 
slowly in order to win permanent victory. 



ON REST AND EXERCISE 193 

little judgment will suffice in many cases to tell one 
when the disease is progressing, and that additional rest 
is therefore demanded. Other hints in this direction 
will be given a little later. 

Fever due to outside influences also calls for rest and 
it goes without saying that fever due to causes entirely 
unrelated to tuberculosis may occur now and then. 
Nevertheless, such incidental rises of temperature may 
herald a serious complication, which can often be cut 
short by rigid rest instituted at the outset. In any 
event, the rise of temperature probably indicates the 
onset of some new development that calls upon the body 
to put up a stronger fight, for which additional output 
of energy is demanded. Hence, the rule should be: 
Rest whenever fever is present, be the cause what it 
may. 

The feelings are not a trustworthy guide to fever and 
to obtain reliable information on this point it is essen- 
tial that the thermometer he used. (For a definition 
and description of the normal temperature, for instruc- 
tions on using the thermometer, and for further illumi- 
nation on this topic, the reader is referred to Lesson 
V, pages 131 and 132.) 

2. Rest When Fatigued or Feeling Badly from Any 
Cause. A tired feeling is Nature's signal that the 
limit of the body's resources is being approached or 
has already been overstepped. This notice one should 
never fail to heed. It is obvious, therefore, that all per- 
sons who are weak or manifestly sick should be at rest. 
When one is ailing, let the reason be what it may, rest 
is almost certain to be of benefit, and will forestall many 
a set-back. The inviolable rule to rest when tired 
or out-of -sorts from any cause, should be instituted at 
the outset. 

Often the patient is met with who, when he grows 



194 LESSONS ON TUBERCULOSIS 

tired, is willing to rest for a short time, or until he has 
become refreshed. At once, however, when he begins to 
"feel fit," he wishes to walk about or take up some other 
form of exercise. True, this patient has saved enough 
energy so that he no longer feels ill effects from lack 
of strength and power; yet he really needs to continue 
the saving of energy until a reserve has been accumu- 
lated, against call for it in the future. In the words 
of one famous physician, George E. Bushnell, retired 
colonel of the U. S. Army, "Whereas he much needs a 
bank account, he acts like a child who must spend his 
penny as soon as he receives it." 

So, do not be afraid to treat yourself generously in 
the use of rest. Try to anticipate the onset of fatigue 
by seeking rest before becoming noticeably tired. Also, 
when already fatigued, make it a point to remain quiet 
longer than is necessary to relieve the immediate tired 
feeling. 

3. Rest Whenever There Is the Slightest Tinge of 
Blood in the Sputum. "Safety First" demands that 
you go to bed promptly whenever a trace of color ap- 
pears in the sputum (unless you are otherwise advised 
by a competent physician with whom you are in personal 
touch*). 

It is true that many who persist in moving around, 
despite the continual spitting of blood, escape serious 
results; yet many others do not escape. Through a 
brief rest at this time, profuse hemorrhages and seri- 
ous, perhaps fatal, consequences can often be averted. 

* Now and then a case of blood-spitting* occurs (a certain 
type of "congestive" hemorrhage, marked by the raising" of 
merely splotches or small amounts of blood) in which a little 
moving about is allowable, and may prove beneficial. Yet, as 
the question whether or not the blood spitting is of the con- 
gestive type can be settled only by the skilled physician, usually 
it would be foolhardy for the sick person to attempt to decide 
the matter and to begin moving around a little on his own 
initiative. Bear in mind, too, that at most one is merely allowed, 
as a rule, to sit up or perhaps walk about the room a little, 
and that even these liberties are to be undertaken very cau- 
tiously. 



ON REST AND EXERCISE 195 

4. Rest When You Take "Cold." If this simple 
formula were made a part of the code of every sufferer 
from tuberculosis, and implicitly obeyed, a long step 
would be taken toward sealing the doom of this scourge. 
Many and many a victim of the disease, already glimps- 
ing the day when he would be able to say to himself, 
"I am well and whole again/ 9 has had his hopes crushed 
irretrievably, solely through catching "cold" and fail- 
ing to care for himself properly. This is indeed a time 
when one should "watch his step." 

Almost everyone knows that the quickest way to rid 
oneself of a cold is to put aside other matters and go 
to bed for twenty-four hours, or for a few days or 
longer, as need be. Yet how many there are who defer 
doing so from day to day, in the hope that the infec- 
tion will run its course without injury resulting. It is 
true that in some cases the cold does finally wear itself 
out, with apparently no serious harm done, even tho no 
attention be paid to it. On the other hand, in too many 
instances, the fire of the disease in the lung is fanned 
into violent blaze, and a setback occurs that may re- 
quire months or years to overcome. Often the signs de- 
noting that the disease is making a new start are so slight 
and so little if at all different from the ordinary accom- 
paniments of the cold itself, that one is wont to put off 
"giving up to it," as commonly expressed, just a little 
longer, to "give the cold a few days more, or another 
week perhaps, to wear itself out" ; while all the time the 
old trouble is getting a firmer and firmer grip upon one. 

One who has previously been well can possibly afford 
to procrastinate in dealing with a cold, but there is 
only one safe procedure for those afflicted with tuber- 
culosis to follow. It is this: When you find that you 
have been unlucky enough to contract a cold, go to bed 
at once, and stay there until you have good reason to 



196 LESSONS ON TUBERCULOSIS 

believe that the infection has burned itself out; then 
get up gradually. 

Let the other fellow laugh if he will. Just let his 
bantering remarks pass in one ear and out of the other ; 
meantime resting serenely in the knowledge that you 
are doing the wise thing. 

It is important that all tuberculosis patients follow this 
plan, but it is doubly important for those who have at 
any time spit blood. 

5. Rest During the Menstrual Period. For women 
who are up more or less at other times, additional rest 
at the time of the monthly flow is strongly to be advised, 
the more so if one's past experience has shown that the 
symptoms are inclined to be more severe at this time. 

6. Rest When the Heart Is Very Rapid. Regard- 
less of other factors, a pulse rate above 110 when one is 
quiet nearly always requires a continuation of absolute 
rest. This rate is to be looked upon as the extreme 
permissible limit for merely the slightest amount of 
exercise even under exceptional circumstances (unless 
contrary advice is given by an understanding physician 
closely supervising the case) : ordinarily, a much lower 
pulse rate calls for complete rest, even tho all other fac- 
tors are highly favorable. 

How to Obtain Complete Rest 

The actual carrying out of the scheme of rest re- 
ferred to in the preceding paragraphs implies that 
the patient is to undress, go to bed, and remain there 
until circumstances arise that justify him in getting 
up. Whether or not he gets up to make his toilet or 
for meals, depends upon the precise conditions that 
exist in the individual case. Ordinarily, the difference 
may be split by having the meals served in bed, at first, 
getting up only for the short time necessary to attend 



ON REST AND EXERCISE 197 

to other wants. If, however, the fever is high, or if 
the patient is evidently quite sick, he should remain 
in bed constantly. This will, of course, necessitate the 
use of a bedpan. 

Every thing that consumes energy is to be looked upon 
as exercise, and is to be avoided except when exercise is 
permissible. One should assume a comfortable posi- 
tion — a position in which the body is not supported by 
muscular effort at any point — all the muscles being 
thoroughly relaxed and at ease — lie as quietly as possible, 
avoid turning frequently, and refrain from making 
sudden movements of any kind ; being particularly care- 
ful to use the arms and shoulders as little as possible. 
When lying on the side it is well to rest on the side 
that makes for relief of cough and ease in breathing, 
and for general comfort. This is a good rule to follow 
when the lungs are nearly equally affected, but if the 
disease is definitely worse on one side, it is frequently 
helpful to lie on this side as much as possible. By 
commencing with a few minutes daily and with con- 
tinued practice it is often possible to accustom oneself 
to resting on the worst side a number of hours daily — 
even for the greater part of the time. This plan is well 
worth a persistent effort, and will not rarely turn the 
scales in Nature 9 s favor. 

Business matters and anxieties of all kinds should be 
put aside; letter writing, long or animated conversa- 
tions; boisterous laughing, prolonged reading — espe- 
cially the reading of exciting stories, or reading that 
calls for deep thought or study — and other things tend- 
ing to prevent mental and physical quietude, should be 
cut to the minimum or wholly abstained from. Tem- 
porary laziness should be cultivated. " Early to sleep' ' 
should be the motto; the aim being to obtain the 
maximum amount of sleep in each twenty-four hours. 



198 LESSONS ON TUBERCULOSIS 

The Advantage of Massage. If it be necessary for 
the patient to remain in bed over a long period (and 
no complications, such as blood in the sputum, exist) 
daily gentle massage of the body will add much to 
the feeling of well-being, and in other ways serve a 
very desirable end. (Directions for giving massage are 
to be found in Lesson XIII.) 

The Importance of a Daily "Rest Hour." It is im- 
portant for those who are able to be up most of the time 
to regularly observe a two-hour rest period after the 
midday meal — say from one to three o'clock, or from 
two to four, as circumstances dictate. This "rest hour" 
serves to divide the day into two parts, and to make a 
complete break in things, and should be set aside as 
a period during which one endeavors to do nothing. As 
a rule, even reading should be laid aside and complete 
relaxation of the body and mind should be sought. One 
should try to sleep, providing that sleep during the day 
causes no material interference with rest at night. 
Those who are confined to bed all the time should seek 
even greater quietude and relaxation during this period. 

Rest As an Aid to Digestion. Just before eating, 
rest holds an especially large influence for good. The 
digestion of food uses up considerable energy, and we all 
know from experience that at times weariness has a 
tendency to take away the appetite (altho in other in- 
stances weariness induces an actual craving for food 
or drink). If, notwithstanding the tired feeling and 
the loss of desire for food, a full meal is eaten, one may 
suffer for so doing. This teaches that rest for half an 
hour or more before eating allows the body to store up 
power against the call for the additional output of 
energy that will come at meal time. If the stomach 
is at all sensitive, rest before meals is doubly important. 

When Talking Should Be Forbidden. When the 



ON REST AND EXERCISE 199 

voice is weak or husky (whether this be due merely to a 
referred influence from the disease in the lung, as it 
often is, or to actual tuberculosis of the larynx or voice- 
box, but particularly in the latter case), rest of the voice 
is especially important. It may be well in such instances 
to speak only in whispers — if at all — and if tuberculosis 
of the throat is present, this is imperative. So, too, in 
cases wherein the act of speaking noticeably provokes a 
spasm of cough, rest of the vocal chords is again of more 
than ordinary importance. 

In the treatment of tuberculosis of the throat, patients 
are often restricted to absolute silence for as long a 
period as may be necessary, and through adding merely 
this simple measure to the health regimen complete heal- 
ing of the throat has frequently been brought about. 
More recently we have learned that in severe or obstinate 
cases of pure lung tuberculosis, irrespective of the pres- 
ence or absence of voice symptoms, silence often proves 
remarkably beneficial. I have had a number of patients 
who after all else had failed as a last resort were advised 
to observe strict silence and to use a writing pad. Those 
who were faithful for weeks or months were not rarely 
rewarded by seeing the whole course of events change, 
and by eventual victory. 

The Voluntary Restriction of Cough. As already 
noted, the act of coughing has a tendency to destroy 
Nature's delicate thread work of healing tissue and to 
spread the disease to parts of the lungs previously free 
from trouble ; so every effort should be made to restrain 
all cough not necessary for raising the secretions. It is 
surprising how much it can be controlled, if one will 
only try. There need be no fear that the intentional 
restriction of cough will hinder the elimination of the 
sputum (unless the sputum has already become so 
thoroughly loosened that the slightest effort will serve to 



200 LESSONS ON TUBERCULOSIS 

remove it). If the cough be restrained, much of the 
sputum is involuntarily carried upward, and is readily 
removed merely by clearing the throat. 

Importance op Sexual Rest 

There is one phase of the subject, Rest, to which 
too little attention is paid by the average patient. I 
refer to sexual rest. From the study of the preceding 
pages it is apparent that the avoidance of excitement 
and the strict conservation of both the physical and vital 
energy are all-essential to recovery. The sexual act 
flies straight in the face of these things. It is the very 
opposite of rest and in addition brings about a most 
undesirable condition of excitement, and may bring on a 
hemorrhage. What is most important and least appar- 
ent, it uses up a material amount of energy — energy 
which is very badly needed for other purposes. 

There is no question that the chances for recovery of 
a good many persons have been lost solely through sexual 
intercourse. For those in health, it has been conclusively 
proven within the last few years that neither abstinence 
nor moderate indulgence is in any degree harmful. But 
with sickness, particularly tuberculosis, the entire situa- 
tion changes. For a patient who is running fever, or 
who is confined to bed for any reason, there should posi- 
tively be no intercourse. When one is on the road to 
recovery and can stand a reasonable amount of physi- 
cal activity without rise of temperature, fatigue or 
other untoward sign, intercourse may usually be per- 
mitted provided it is held down to an absolute minimum. 

In this connection a word to the other partner of 
the union may not be amiss. Too often the husband or 
wife, in perfect health and abounding with energy, quite 
fails to realize the harm that may accrue from so simple 
an act. If the well partner will remember that the fight 



ON REST AND EXERCISE 201' 

against tuberculosis is a fight for life, he will at all times 
make certain that he says nothing and does nothing that 
directly or indirectly may tend to raise the absolute 
minimum which the patient establishes. This may be a 
sacrifice, but it is a sacrifice that is distinctly necessary 
and distinctly worth while. 

Unwarranted Fear op Rest 

There is an opinion prevalent that if the sufferer from 
tuberculosis goes to bed, he will become weaker and 
weaker, until finally he may never be able to get up and 
about again. A more serious mistake can hardly be 
made than to permit one's actions to be governed by 
this belief. It is more nearly correct to say that, if 
despite the fact that the invalid's condition calls for 
a rest he persists in staying up and around, he will be- 
come so much worse that eventually he will be forced to go 
to bed. Then, truly, he may never get up again because he 
has waited so long that his condition has become hopeless. 

Fear of Best Is Unwarranted. True, when one who 
for some time has been working under a continual strain 
and daily overdrawing on his fund of strength, is put to 
bed, and the matters that have occupied the mind and 
diverted his attention are laid aside, he may for the first 
time awaken to the fact that he is completely worn out. 
It is then rather easy to fall into the error of assuming 
that the rest in bed has been the direct cause of the 
weakness; whereas the fact is that the removal of the 
false strength of nervous excitement has merely served 
to reveal the state of affairs previously existing. 

Still, there is a grain of truth in the belief that as a 
result of remaining in bed over a long period, one loses 
a certain amount of strength or muscular power; but 
commonly an erroneous interpretation is placed upon 
this fact. When the muscles are idle it is but natural 



202 LESSONS ON TUBERCULOSIS 

that a certain amount of wasting from their non-use, 
accompanied by a corresponding loss of power, should 
become manifest. None the less, unless the period of 
rest is exceedingly prolonged, the loss is more apparent 
than real. That is, the ability to coordinate the muscles 
is diminished, but actual energy is stored up, and a 
substantial bank account accumulated against the proba- 
ble demands of the future. Even those who are healthy 
commonly experience the same harmless feeling of weak- 
ness as a result of rest. 

For this reason, if debility comes on as a result of 
rest in bed, there need be no concern. Later, when with 
practise the knack of walking is reacquired, in all like- 
lihood the temporary feebleness will be displaced by 
renewed vigor. Remember, however, that just as a child 
requires time to learn to walk, a certain interval for 
re-education of the muscles must necessarily elapse 
before the previously latent strength becomes evident. 

For those who are well, excessive rest no doubt means 
rust, but it is also a fact that they, too, would avoid 
much sickness by occasionally seeking at least relative 
rest and relaxation. 

Rest versus Nervousness and the "Blues" 

In deciding on the exact amount of rest necessary, the 
temperament must be given due consideration. The 
nervous, fretting, fidgety individual who is continually 
brooding and chafing while under restraint, may de- 
feat the very object of the whole scheme by preventing 
himself from obtaining sufficient mental rest. Tem- 
peraments of this nature, sufficiently strong to have a 
contrary bearing against rest, are however not common. 
True, nine out of ten persons think they are the excep- 
tions, and give voice to their beliefs in some such expres- 
sion as, "I have never had a sick day and have always 



ON REST AND EXERCISE 203 

led a busy life: I know that I cannot remain quiet 
and relax, while in bed." Yet after giving the plan a 
fair trial for a week or so, most of these pessimistic persons 
are surprised to find that they do obtain relaxation and 
repose, and see for themselves that rest is very beneficial. 

As a rule, if the invalid will only make up his mind 
to accept the conclusion of the highest authorities that 
rest and repair go hand in hand, and once and for all 
convince himself that rest is what he needs, he will be- 
come contented and secure the full benefits of rest. 
Experience has demonstrated that rest itself is often 
the best remedy for nervousness. Often, too, those 
who fight hardest against rest are the ones who need 
it most. 

For those who are prone to worry and fret, the fol- 
lowing simple expedient, suggested by the noted medical 
authority, Colonel Bushnell, of the U. S. Army, often 
proves helpful. Just select some particular time in the 
day as a "worrying hour," in which you are to do all 
the worrying you desire ; try pooling all the worries for 
the whole day in this period, and you may be agreeably 
surprised to find not only that it is impossible to force 
yourself to worry at the set time, but that you are less 
and less inclined to worry at other hours. 

Other helpful suggestions for doing away with worry, 
despondency, fear and dread will be given in Lessons 
XIII and XIV. 

Wading-in versus the Bold Plunge. Not uncom- 
monly, those who abhor the idea of going to bed make 
some such appeal as the following: "Doctor, I have 
lived with myself for a good many years, and I feel 
sure, therefore, that I know myself as you cannot. If 
I do as you wish, and go right to bed, I am confident 
not only that I will not gain, but that I will actually 
lose. May we not compromise? If you will be satis- 



204 LESSONS ON TUBERCULOSIS 

fied to have me sit around most of the time and lie 
down an hour or two each day, I believe that I can 
change my habits to that extent, with benefit. But if 
you force me to remain in bed constantly, I am sure that 
I will only worry and brood, lose heart completely, and 
fail in the end." 

When a patient speaks in this manner, if I am con- 
vinced that the circumstances as a whole call for abso- 
lute rest, I am accustomed to answer in this vein : " There 
is, of course, logic in your plea. Yet if you will once 
consent to immediately relinquish everything that holds 
you back, promptly cutting all unnecessary outside ties 
that hinder you from focusing your attention exclusively 
on your recovery, you will almost certainly be the gainer. 
Please remember, too, that once you have made up your 
mind to accept the inevitable, it will probably be easier 
for you to find peace of mind and contentment while 
in bed than it will if you put only half your heart into 
the fight, and enlist merely half-way measures in your 
cause. If you are only lukewarm from the start, the 
partial liberties will probably but serve to add to your 
discontent and perhaps lead you to cast aside all caution 
and care. 

"Now be a good sport and take the plunge boldly. 
Have it over with at once, and you will soon find that 
rest pays." 

Modification of Program Sometimes Desirable. 
Nevertheless, in a few instances some allowance must 
be made for the extreme mental restlessness and 
despondency that develops when one is under forced re- 
straint. In such instances, a slightly modified program 
may give better results.* 

Yet if rest is otherwise called for, the fact should 



* In this case one may find recuperation in variety and change 
of experience, which prevents exhaustion of one group of nerve 
cells, rather than by complete rest of the body as a whole. 



ON REST AND EXERCISE 205 

not be lost sight of that if a way can be found to put 
oneself at ease, firm adherence to the rest schedule one 
has previously worked out for oneself will continue to 
be the better plan. 

How Long Should Rest in Bed Be Continued? 

When fever is present, a week, a month, or many 
months may pass before a decided fall in the tempera- 
ture becomes evident. It is usually wise for those who 
respond readily to remain at rest in bed until the tem- 
perature has become normal (this means, in most cases, 
until the temperature stands at 98.6° F., or below — 
see Lesson V, p. 132, for a more complete description of 
normal temperature), and for a sufficient time there- 
after to obtain reasonable assurance that the fall is per- 
manent. In some instances quite a long period will be 
required for the lowering of the fever and one should not 
be discouraged if the drop in temperature does not take 
place quickly ; for in many cases of this type the ultimate 
results are most gratifying. 

Whether or not it is best to persist at absolute rest 
after having reached the conclusion that the tempera- 
ture has come down to stay, depends upon individual 
circumstances, concerning which only a suggestion can 
be given here. If in doubt, one can never go astray by 
falling back on the time-worn but nevertheless trust- 
worthy maxim that so long as one keeps on mending at 
a fair rate of speed (as shown by the abatement of other 
symptoms), unless there be some strong reason for doing 
otherwise, it is usually a poor policy to interrupt the 
treatment that has been responsible for these good 
results. 

If, in the given case, fever has been absent and the 
necessity for rest has been based upon other factors (as 
indicated earlier in this lesson) the decision as to re- 



206 LESSONS ON TUBERCULOSIS 

ducing the amount of rest must depend mainly upon the 
abatement of these factors. So long as any signs indicat- 
ing that the disease is making headway remain, rest is 
in order, unless some circumstances, such as those now to 
be discussed, make desirable a modification of the pro- 
gram. 

Circumstances That May Necessitate Modification 
of the Rest Schedule. Should (1) the decline of fever, 
or (2) the abatement of activity of the disease (in those 
cases where other items than fever have furnished the 
basis of rest) occur very slowly or not at all, it is some- 
times inadvisable for one to adhere exactly to the regi- 
men of complete rest until (a) the precise normal 
temperature is reached or (b) until all activity of the 
disease has ceased. Altho if other things are going well, 
it is often desirable for one to remain at rest in bed even 
in such cases. 

Ordinarily, improvement in digestion, sleep and most 
other bodily functions goes hand in hand with rest. 
But sometimes an opposite effect is noted: a flagging 
appetite, disorders of the stomach and bowels, sleepless- 
ness and very marked nervousness, accompanied by hours 
of gloominess and despondency, develop. Manifesta- 
tions of this nature sometimes overbalance the beneficial 
effect of continued absolute rest. Should these or similar 
symptoms occur, some slight liberties, such as sitting 
up or other small changes, may be cautiously allowed; 
or some harmless pastime (such as those suggested on 
p. 219) may be taken up, and the effect carefully watched. 
Bear in mind, however, especially if you have more than 
slight fever, that you will probably notice, and should 
be prepared for some disturbances of the nature just 
described, irrespective of the amount of rest taken. 
Even when such undesirable symptoms have occurred, 
it is seldom wise to materially modify the rest plan until 



ON REST AND EXERCISE 207 

a trial of at least several weeks or months of rest in 
bed has failed to produce results. Moreover, even under 
unusual circumstances a relaxation of the routine is 
rarely advisable when the maximum temperature is 
above 99.5° F., or when signs of any nature indicate 
more than the slightest activity of the tuberculosis. 

When a modification is decided upon, if the new 
privileges be taken up more with the idea of obtaining a 
harmless and pleasant change making for peace of mind 
and contentment, rather than for any direct benefit, 
one will sometimes be agreeably surprised to find that im- 
provement follows. If the change produces no aggrava- 
tion of the temperature or other symptoms, a little later 
the scheme of management may perhaps be further 
modified. 

The question is frequently asked : Is it possible to se- 
cure too much rest! The saying, "If a little medicine 
is good, more is better," has often been proven false; 
and there is of course a limit to the value of all good 
things, including rest. Yet it is safe to say that if the 
matter be left to the decision of the sick person, in 
nine cases out of ten he will be inclined to take too little 
rather than too much rest. Excessive rest does no 
great harm, while too much or too early exercise may 
produce serious results and even mean ipermanent 
defeat ; hence ; when one is in a quandary, it is safer 
to err on the side of rest. 

Exercise the Great Reconstrtjctor 

The Getting-up Period. As convalescence, marked 
by the fall of the fever and the disappearance of other 
symptoms, continues, sooner or later the getting-up 
period arrives. When this day comes — a day probably 
looked forward to with yearning and pleasure — make 
sure that you guard yourself carefully against allowing 



208 LESSONS ON TUBERCULOSIS 

the abounding feeling of joy to lead you to make too 
sudden or too wide a change in your habits. Make each 
little transition very, very gradually. At first, for 
example, you may merely sit up in bed for a short time — 
say for perhaps fifteen minutes — a period which may be 
lengthened from time to time if all goes well. (Sitting 
in bed is much easier if a back rest of some sort is used, 
and a number of manufacturers now supply ready-made 
back rests that are adjustable at various angles, which 
are very convenient.) 

The next little undertaking is sitting in a chair. In 
the beginning this is to be continued for only a few 
minutes each day ; an allowance which later may be ex- 
tended to a half -hour, then to an hour or several hours, 
once or twice a day. 

A further promotion is walking, consisting at first 
merely of a few cautious steps across the room; the 
walking thereafter being gradually increased, as the day- 
to-day condition permits. 

The Importance of Exercise When Permissible. 
Under normal conditions, moderate exercise, by improv- 
ing the circulation of the blood and increasing the supply 
of nourishment to each tissue and cell of the body, makes 
for a better functioning of each and every organ. In 
health, therefore, a certain amount of daily exercise is 
necessary if one is to enjoy life to its fullest degree. 

Here is an incident that illustrates this point. Nowa- 
days it is a common observation that moderate use of an 
automobile tire lengthens the life of the rubber. He 
who wishes, may verify this statement by experimenting 
with two tires. If one tire be laid aside and the other 
employed in travel a few miles daily, at the end of a 
year the tire that has been in service will probably be 
found capable of still giving considerably more mileage, 
whereas the unused tire will be so stiff and lifeless that 



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ON REST AND EXERCISE 209 

after a short run it will show its worthlessness by 
chipping or falling to pieces. Similarly, moderate use 
of the healthy human body makes for longer life. 

How Moderate Use of the Body Sometimes Pro- 
motes Recovery. Likewise, in certain cases of tu- 
berculosis, a small amount of exercise taken daily has 
a tendency to directly promote healing in the lungs. 
Thus, occasionally, cases are encountered in which, 
despite faithful and prolonged adherence to the rest 
program, the disease continues to progress. In such a 
case, provided the disease is only slightly active, if one 
very cautiously begins to exercise just a very little bit 
each day, a turn for the better may occur. 

The benefit which follows exercise in instances of this 
character has — to take up again the illustration set 
forth earlier in this chapter — its counterpart in the 
knitting of broken bones. For example, when a long 
period of immobilization of the limb has failed to pro- 
duce results, the surgeon sometimes modifies the plan 
of absolute fixation and (guarding the injured member 
against undue movement by the application of suitable 
splints) allows the patient to use the limb a little. As 
a result of this change, owing to the improvement in 
the circulation which ensues as a result of the irrita- 
tion produced by the mechanical rubbing together of the 
bone ends, healing may be stimulated just enough so 
that the break finally mends. 

In like manner, the improved circulation of blood 
through the lungs brought about by moderate and ra- 
tional exercise may now and then prove of benefit. 
This statement does not refer to the intentional exercise 
of the lungs by voluntary deepening of the breathing, 
but relates to the augmented circulation through these 
organs, in turn primarily due to the invigoration of the 
entire circulation as a result of a very limited and 

14 



210 LESSONS ON TUBERCULOSIS 

guarded use of the whole body, but which is also in part 
attributable to the involuntary deepening of the breath- 
ing which necessarily accompanies general exercise. 

On Building Up the Body. At the end of the 
rest "cure," the convalescing patient usually finds him- 
self rather soft and flabby. If he is to do more than 
just passively exist or be merely a fairly healthy loafer, 
if he is to fill a real place in the world, he must be 
hardened and toughened and put into shape to withstand 
the wear and tear of everyday life. At this time, then, 
if there be no valid objection to its use, exercise fills 
an essential need. Hence, if all goes well during the 
getting-up period, the liberties should be progressively 
increased as circumstances warrant. This period of 
seasoning is often neglected by those who are con- 
valescing, to their xdtimate regret. 

The directors of most sanatoria consider this one of 
the most important features of the treatment. But un- 
fortunately, for one reason or another, in many instances 
patients leave the institutions and revert to their former 
habits or perhaps take up work again before they have 
been hardened and fitted for the grind of ordinary af- 
fairs. Accepting at its face value the circumstantial 
evidence that they look and feel well ; failing to see, or to 
believe, that their lusty appearance and feeling of 
strength is mainly due to their idleness — quite unmindful 
of the fact that they have not yet been tested; not 
realizing that what they have acquired is so far largely 
a shell of health— overlooking these things and perhaps 
thinking that they "will take it easy for a while" (a 
thought that usually proves a delusion and a snare), 
prematurely and rather suddenly they slacken their ef- 
forts, or perhaps break off the rest treatment entirely, 
and jump back into harness. 

What is the result? Too often there follows a re- 



ON REST AND EXERCISE 211 

lapse, which with reasonable certainty could have been 
averted had more time been given to the treatment at 
this, the great danger period. 

One should memorize well the fact that the object 
of treatment is not only to cure the disease but, in so 
far as possible, to nullify its results. Judicious and 
systematic retraining of the muscles and organs for 
their various duties is highly necessary, if one is 
to build a sound foundation for permanent health. 
The disease has been known to heal, yet death occur. 
This paradox of " death from improvements' f is usually 
caused by the failure of one of the vital organs, damaged 
by the chronic poisoning and strain it has undergone dur- 
ing the siege of sickness. Proper conditioning of the 
individual, by carefully graded exercise at the right 
time, will prevent many of these deplorable occur- 
rences, and thus save many a heartache. 

What Forms of Exercise Are Advisable? 
Walking is the form of exercise suitable for most pa- 
tients. After the getting-up period has passed, and the 
patient has become accustomed to moving about the room 
or house, he may begin to step outside a little. If all 
works smoothly, from then on the daily walk should be 
gradually lengthened. In the average case, after a few 
days, an increase of perhaps one or two hundred feet 
daily or every few days may be made, the exact amount 
of the increase being governed by the effect. Still later, 
if the case is fitting, the walk may be progressively in- 
creased to a half-mile, to a mile, and so on ; until, as the 
walks are extended more and more, the individual is 
gradually enabled to walk three to five miles or more 
each day without ill effect, or to spend several hours at 
a time on his feet.* 

* For those whose work is largely mental, who have been 
accustomed to take but little exercise and who know that they 



212 LESSONS ON TUBERCULOSIS 

Later, other forms of moderate exercise, such as chair 
seating, pottery making, the carrying of light loads (no 
heavy lifting), vine trimming, light gardening (no hoe- 
ing), lawn raking (no mowing*), or other kinds of light 
work, may serve both as time consumers and to fit one 
to again earn his livelihood. 

Other suggestions along this line, with detailed in- 
structions for carrying out the various crafts described, 
may be found in a very handy and useful manual en- 
titled " Handicrafts for the Handicapped," by Hall 
and Buck, carried in stock by the Journal of Outdoor 
Life, 370 Seventh Avenue, New York. 

General Instructions for Exercise 

At the outset, it is well to take the walks or other ex- 
ercise at the time when the temperature is lowest, which 
is usually in the morning. Later, an evening period for 
exercise may be added. 

IMPORTANT GUIDES 

Walk slowly and rest frequently. Do not run or 

make any violent exertion. For a long time, make it a 
point to walk only on the level. If the walk must be 
made on a grade, it should be so arranged that return 
is made down-hill. Mountain climbing should be con- 
sidered strictly prohibited, unless on the direct advice of 
the physician in charge. Stair climbing should be 



will be forced to fall back suddenly into sedentary habits, the 
accustoming to long walks is less important than for those who 
do manual work. However, whether or not long walks are taken, 
a long period of seasoning in which some exercise is taken is 
important in any case. 

* Owing to the fact that these lessons are written for pa- 
tients in all stages of the disease, each with his own peculiar 
problems, it is impossible to avoid being somewhat dogmatic in 
^formulating rules. For example, here and there an exceptional 
pa.tient may be able to do a little lawn-mowing without ill ef- 
fect, but for the majority, the act is too strenuous. A little 
leeway may therefore occasionally be allowed in interpreting 
these rules or items in the individual case, but under no cir- 
cumstance should the variance be great. 



ON REST AND EXERCISE 213 

avoided. Never start to go a set distance, and bear in 
mind that you must return. Do not allow yourself to be- 
come tired or materially short of breath, or exercise suf- 
ficiently to produce cough. At all times guard yourself, 
remembering the saying: "The healthy man sits when 
he is tired, but the consumptive must sit that he should 
not become tired. ' ' 

Regularity. Exercise, once begun, should be taken 
regularly, unless for good reason. How often it is 
that persons with brightest outlook permit whims, 
mere inconvenience, personal distaste, laziness, or other 
small factors to interfere with the business in hand. 
Through half-hearted dilly-dallying and spasmodic ef- 
fort—overdoing one day, doing too little the next — they 
lose what little they have gained, and are finally passed 
and outdistanced by others who,, with only a small 
chance at the beginning, yet have made good through 
consistency and perseverance. 

It is seldom the case that a gentle shower or slight fog, 
or moderate cold, alone, should be allowed to veto the 
daily walk. Extreme inclemency of the weather, such as 
is due to violent wind or bitter cold, is sometimes an ex- 
ception. (Of course, sufficiently warm clothing should be 
worn, and other appropriate articles for protecting one 
against the elements, such as mentioned in Lesson XI, pp. 
279 and 280, made use of.) 

If, however, for any reason the daily exercise is 
curtailed or omitted, when begun again, drop back 
correspondingly in the length of the walks and again 
gradually increase them, as before. Make each increase 
very gradually and aim to desist short of any note- 
worthy feeling of tiredness. Note that the injurious 
effect of overexercise is often not manifested at 
once, and that in some instances it never becomes 
directly evident, but is shown merely by a failure 



214 LESSONS ON TUBERCULOSIS 

to convalesce as rapidly as would otherwise occur. 

Quite frequently excessive exercise produces an eleva- 
tion of the bodily temperature, but the rise does not 
necessarily take place on the same day. In other cases 
overexercise produces a drop in temperature, due prob- 
ably to the exhaustion of energy. 

No Exercise When the Sputum Contains Blood. 
Unless contrary advice is given by the physician in 
charge, the rule should be scrupulously maintained not 
to exercise when there is even the slightest trace of color 
in the sputum. 

For other guides to exercise, the reader should turn 
back to the topic "Rest" in the first part of this chapter. 
This section should be read carefully before taking up 
exercise in any form, bearing in mind that when rest is 
indicated, exercise is prohibited, and vice versa. 

Advisability of Noting the Results and Regulating 
the Amount Accordingly. The effect of exercise 
should be watched, and if untoward symptoms occur, no 
further increase should be made for a time ; or if neces- 
sary the walks should be cut down temporarily, or even 
foregone entirely for a while. In some cases a loss of 
weight occurs. If this loss is but slight, and other 
symptoms are not noted, no concern need be felt. If one 
has been previously overeating or has put on a large 
amount of weight, a slight loss is almost to be expected. 
But if much weight is lost, or even a small loss is progres- 
sive, curtailment or even absolute interdiction of exercise 
may be in order. 

Commonly a mild shortness of breath and general 
feebleness accompany the first attempts at exercise. As a 
rule, these symptoms gradually wear off with practice. 
So, altho they are to be looked upon as an additional 
warning to go slowly, such symptoms are not alone to be 
considered as a bar to a small amount of exercise when 



ON REST AND EXERCISE 215 

otherwise indicated, unless they are pronounced or very 
persistent. A moderate increase in the pulse rate dur- 
ing, or shortly following, exercise is also to be expected, 
but the pulse should fall to its previous rate within 
twenty minutes or half an hour. 

PRECAUTIONS FOB CERTAIN PATIENTS 

Those patients suffering from advanced disease, es- 
pecially elderly persons, should use extraordinary dis- 
cretion in extending the walks. For some in this class, 
even tho the lung condition has improved remark- 
ably, or has even healed entirely, long walks, or their 
equivalent in other forms of exercise, never become 
advisable. If the destruction of the lung has become 
extensive or the other organs seriously crippled, Nature 
may be unable to entirely pay back the loss, at least 
for a long time, perhaps never. 

When living a life of moderation, such persons seem 
as well as their more vigorous friends, and may attempt 
to follow the example of the latter. They should re- 
member, however, that they have no reserve, and that 
no matter how rugged their outward appearance, nor 
how strong they feel when at rest or doing little, they 
must not permit themselves to be deceived. Those so 
afflicted may enjoy a life of moderate activity, but must 
content themselves to always keep well within the limits 
of their own life resources. 

Afternoon Rest Hour Should Be Observed Faith- 
fully for a Long Time. Even after one is up and 
about the greater portion of the time, the afternoon rest 
hour should be faithfully observed for at least a num- 
ber of months, and in some cases for years. To many 
this will prove a life-saving boon. 



216 LESSONS ON TUBERCULOSIS 

The "Work Cure" and Vocational Training 

Persons who hear of the "work cure" for tuber- 
culosis are sometimes skeptical as to the real value of 
rest. Let it be understood, therefore, that the work 
cure, as carried out under the directions of physicians 
who are actually getting results, is based on the same 
general principles as the treatment described in this 
lesson. The name is misleading. 

The sponsors of the "work" plan believe thoroughly in 
rest when the disease is materially active, but insist, in 
selected cases only, on the great value of carefully graded 
exercise — which may take the form of mild, carefully sys- 
tematized work in certain instances. Some of the advo- 
cates of the so-called "work cure" favor instituting ex- 
ercise a little earlier than is ordinarily practised, but 
in no instance is it begun before the disease is at least 
quiescent. One should not fail to note the fact that 
any attempt to carry on one's regular occupation is 
liable to end in failure. (Those who must work at 
the same time that they are putting up a fight for their 
lives should on the other hand by no means give up hope, 
but should remember that faithful adherence to the other 
rules for recovery may make up for the failure to abide 
strictly by this one. However, unless forced to earn one's 
way, it would be utter folly to continue at regular em- 
ployment while "taking the cure.") 

Nevertheless it has been thoroughly proven that in 
certain cases the return of health is materially hastened 
if the patient is permitted to take up some light and 
strictly limited avocation or vocation during the build- 
ing-up period. For a number of years it has been the 
policy in many sanatoria in carefully chosen cases as 
soon as the condition of the patient permits to give him 
some agreeable, easy work to perform each day. This 



ON REST AND EXERCISE 217 

work, either mental or physical or both, is carried on 
regularly under the close supervision of the phy- 
sician. 

In this way the interest of the patient is often sus- 
tained at a time when because he feels so energetic he 
is apt to grow careless and perhaps spoil his chances en- 
tirely by radically breaking away from the health pro- 
gram. Then, too, it is very encouraging to find oneself 
again accomplishing something useful. So the combined 
result of these and other influences is an actual boost 
toward recovery. 

More recently special vocational training along definite 
lines has been introduced in a number of sanatoria during 
the final phase of the patients' sojourn. Such train- 
ing is not of course adapted to all cases, but is particu- 
larly useful for those who have previously led very active 
lives and who find difficulty in holding themselves under 
control unless their time is at least fairly well occupied. 
For this reason vocational training finds perhaps its 
greatest sphere of usefulness in the treatment of tuber- 
culous soldiers and sailors. In any case, the work is 
undertaken only during the building-up period and is 
even then taken up very gradually, at first for only an 
hour or two a day. There is no question that in cer- 
tain cases the right sort of systematized training has 
helped greatly toward fitting the patients for a useful 
place in the world's affairs, but it should be understood 
that the success of the program is in direct proportion 
to the care used in supervising the patients, coupled 
with the fact that the training is along interesting and 
suitable lines of endeavor, which necessarily differ in 
each case. 



218 LESSONS ON TUBERCULOSIS 

The Question of Gymnastic and Deep Breathing 
Exercises 

The exact place of exercise of the lung — deep breath- 
ing — in treatment, is as yet unsettled. That many who 
lend encouragement to the plan of deep breathing have 
not a clear understanding of tuberculosis is decidedly 
unfortunate. Ofttimes basing their arguments on the 
fallacious belief that lack of oxygen is the essential cause 
of tuberculosis, they claim that the inhaling of more 
oxygen through deep breathing will be an important 
help toward cure. Strange as it may seem, this old idea 
has long ago been largely exploded,* but the dis-. 
covery that this is true in no way lessens the value of 
fresh air. (See passage under the heading "The Effect 
of Fresh Air" in Lesson XL) 

The question of deep breathing during health is en- 
tirely different, but there is no doubt about the fact that 
exercise of the tuberculous lung at the wrong time, by 
injuring the delicate healing tissue and by spreading the 
disease, has done much harm. Whether or not lung 
exercise is useful as the disease becomes arrested is to 
be determined by the expert physician, who will decide 
each case upon its individual merits. One difficulty is, 
that once having commenced deep breathing, many, per- 
haps most patients, will fail to adhere systematically 
and consistently to the daily schedule of deep breath- 
ing unless the breathing exercises are carried out under 
an instructor in unison with other persons. As irregu- 
larity itself works harm, this furnishes further evidence 
against the advisability of exercise of the lung in the 
ordinary or average case. In selected cases, on the other 

• In truth, the facts warrant the statement that ordinary 
pure air, taken into the body in ordinary amount (or in such 
quantity as is regulated automatically by the involuntary deep- 
ening of the breathing in accordance with the immediate re- 
quirements), supplies the body with all the oxygen it can 
utilize, even in tuberculosis, save under exceptional circum- 
stances. 



ON REST AND EXERCISE 219 

hand, as or after the disease is arrested, judiciously 
carried out, certain lung exercises are worthy of trial. 

General Gymnastics. Similarly, mild calisthenic 
exercises, altho unquestionably worth a great deal in 
suitable cases (chiefly early cases, and not by any means 
all early cases) in seasoning the patient after the dis- 
ease is fairly well arrested, may cause irreparable dam- 
age if applied in a hit-or-miss fashion. Some physi- 
cal directors who do not have a proper knowledge of 
tuberculosis do harm by advising physical exercises for 
persons who, altho apparently well, are suffering from 
unrecognized tuberculosis. 

Under no circumstances should either deep breath- 
ing or gymnastic exercises be taken up, except on the 
advice of a competent physician conversant with the 
peculiarities of the given case. First and last, let it 
be remembered that health and endurance are wanted, 
rather than great strength. The price demanded for 
large muscles and the figure of an athlete may be far 
too heavy to pay. 

Amusements and Pastimes 

As soon as the condition of the invalid permits, the 
taking up of some suitable diversion will prevent time 
from becoming a drag, will help to keep gloom and worry 
at a distance, and indirectly hasten recovery. The one 
essential is, that the pastime itself be incapable of work- 
ing harm. 

The invalid who is not extremely ill may be read to 
in moderation; a little later he may himself read a lit- 
tle. It is important that the bed be so placed that a 
good light falls on the book, and that the bright sky is 
not faced. This simple precaution, if heeded, will 
obviate much headache and discomfort. So too, crochet- 
ing, knitting, or a little later, when one is able to sit in 



220 LESSONS ON TUBERCULOSIS 

a chair, basket weaving, carving, art metal work — each 
has its place. For many women knitting especially 
seems to furnish the charm that brings a mental ease and 
repose which can be secured in no other manner. Again, 
some of the milder table or bed games, such as solitaire, 
checkers or dominoes, may be made to serve a similar 
purpose. On the other hand, card playing is not usually 
permissible, because of its tendency to provoke excite- 
ment, while chess requires too great an expenditure of 
energy. Later, when exercise is permissible, painting, 
photography, music (light playing only), nature study, 
a love for birds (which may be studied through opera 
or field glasses) and flowers, or some cultivated hobby, 
will serve the same end. 

Games, such as pool or billiards, bowling with a light 
ball (exceptionally), croquet; short auto- rides,* pro- 
vided the invalid does not drive the car ; motor boating 
(no rowing) on a small, calm body of water ; boat fish- 
ing (trout fishing in streams is too strenuous) ; target 
practice with a light rifle (or even the hunting of small 



* When the patient becomes able to get up and about a little, 
occasional or even fairly frequent motor rides (unless riding in 
an auto makes the patient very excited or nervous — some ner- 
vousness being almost natural at first) will prove not only 
enjoyable, but probably beneficial as well. The continually chang- 
ing scenes inspire an altogether new sequence of thoughts which 
keep the patient from growing introspective, which, together with 
the bracing effect of the moving air, make for more restful sleep, 
a greater zest for food and a general invigoration. Those who 
are thoroughly impressed as to the value of rest, often fear that 
motoring entirely violates the rule of rest, and defer getting out 
in the auto longer than necessary. It goes without saying, that 
only very short rides should be taken at first, and the speed 
should be slow, but no anxiety should be felt because of the 
moderate jolting that may ensue. Some are afraid that a 
hemorrhage will be brought on, or other complication occur. As 
a matter of fact, altho the bouncing about and jolting of the 
body is likely to make the muscles and other parts of the body 
somewhat sore or to bring on an ache or pain here or there (a 
common effect no matter how long the first ride is postponed), 
there is less chance of harm from this largely external shaking 
than there is from forcible coughing, loud talking, boisterous 
laughing, singing, or other acts that provoke deep breathing and 
produce a direct irritation in the disease area. In some cases, 
wherein it seems essential to modify the rest program a little 
sooner than customary, the good derived from fairly early auto 
rides (or short trips in a buggy) may more than compensate for 
the slight infraction of the rule of rest. 



ON REST AND EXERCISE 221 

game, if the hunter is content to confine "the chase' * 
to a leisurely stroll on level land) — are all useful in 
moderation. In milder cases, near the end of the build- 
ing-up period, horse-back riding, and auto-driving if 
the car be light and easily handled (no cranking) are 
sometimes allowable. Golf (with the full swing), ten- 
nis, baseball, football, handball, basketball, bicycling, 
polo, boxing, dancing, surf -bathing, swimming and other 
pastimes that require violent exertion are to be resolutely 
tabooed. 

At first only a short time should be given to these 
amusements, and one should never persist long enough 
to cause fatigue or nervousness, to produce a rise in 
the bodily temperature, or to bring on other detrimental 
effects. Remember that the glow of excitement and 
pleasure may entirely mask one's real feelings for 
the time; not till later does a reaction show that one 
has done too much. Make it a point, therefore, to 
take up nothing that cannot be laid aside at any time, 
and to stop short of all tired feelings. Tasks of all 
kinds should be strictly forbidden. 



LESSON X 

THE SECRET OF EATING TO WIN 

The ultimate attainment of victory over tuberculosis 
depends to a large extent on the maintenance of at least 
fair digestion to the end of the battle; hence it is im- 
perative that every precaution for the protection of the 
delicate digestive organs be taken. Inasmuch as hit-or- 
miss methods in eating have often led to failure, it is 
obvious that those who are bending all efforts toward 
recovery will do well to give careful study to the matter 
of dietary. Altho it is not possible to describe in detail 
a dietary suitable for everyone, rules of a general na- 
ture can be given, which will serve as a guide in select- 
ing foods for the individual case. In making the selec- 
tion, two fundamental principles should constantly be 
kept in mind. The first is : Eat the least amount that 
will produce satisfactory results. This precept will be 
most easily followed by endeavoring always to live up 
to the second rule, which is: Eat foods that count. 
Other guides will be mentioned later, but it will be well 
now to examine these basic laws more closely in order to 
ascertain their exact meaning. 

1. Eat the Least Amount That Will Produce Satis- 
factory Results. This statement at once brings to 
mind the question: Does a satisfactory result mean a 
gain in weight? The answer is that improvement is 
usually, tho not always, accompanied by a gain in 
weight ; but this is not the primary object for which one 
should strive. If much flesh has been lost, this will 
probably be gradually restored as healing in the lungs 

222 



THE SECRET OF EATING TO WIN 223 

occurs ; further, if a state of buoyant health is regained, 
such as one has not enjoyed for years previously, the 
weight may even climb above its previous average and 
remain at this higher point. An increase in weight, if 
not extreme and made on moderate rations, is of value. 
On the other hand, it should be distinctly understood 
that a gain in weight alone is worth little ; and flesh taken 
on rapidly as a result of overeating may be worth less 
than nothing. 

The chief aim of treatment is to secure healing of the 
disease, and, practically speaking, only so far as weight 
acquired means a gain in energy and lung-repair, is it 
of value. In some cases the process of repair requires so 
much energy that, altho an ample amount of food be 
eaten and digested, weight may not be put on, or may 
even be lost, notwithstanding the lungs are healing. 
Some persons who recover completely never become as 
heavy as they formerly were. On the one hand, if one 
who has lost flesh can gain moderately in sound flesh 
without at the same time doing oneself harm in other 
ways, the vital power for overcoming the malady is 
usually correspondingly increased; moreover, a reserve 
is being developed, upon which one may fall back in 
case of future breakdown or complication. The gradual 
building-up of sound flesh, if associated with other evi- 
dences of improvement, may therefore be accepted as a 
fairly reliable index that the lung condition is progress- 
ing satisfactorily. On the other hand, if other signs 
indicate that one is doing well, no concern need be felt 
over the failure to gain weight, or even the loss of a 
little. Broadly speaking, a comparatively steady gain of 
a pound or two a week, or less, is worth more than a very 
rapid gain. 

In considering the injunction that the least amount 
of food necessary should be eaten, it should be under- 



224 LESSONS ON TUBERCULOSIS 

stood that this does not mean, except in extraordinary- 
cases, that one should eat less food than has been one's 
custom when well. On the contrary, the dietary of the 
sufferer from tuberculosis should usually be somewhat 
larger than in health. This means that if, yielding to a 
failing appetite, you have fallen into the habit of eating 
exceedingly little, you must now consume a considerably 
larger ration. Remember that you have not only to 
meet the ordinary requirements of life, but that your 
body continually requires extra energy with which to 
fight the disease, so that your present needs are actually 
greater than before you became ill. 

You should endeavor to meet this increased de- 
mand mainly by eating the proper kinds of food, by 
adhering rigidly to the other rules for eating and liv- 
ing, and by conserving the energy through rest. If, in 
addition, you eat three rather generous meals daily, this 
will probably be adequate. In this case, eating be- 
tween meals is not only uncalled for, but may do harm. 

2. Eat Foods That Count. How many persons 
there are, who eat a sufficient quantity of food, yet fail 
to gain. The root of the trouble in many of these cases 
is that the digestive organs are taxed needlessly with 
edibles that contribute little to the fighting efficiency. 
The solution of the problem is the eating of foods that 
furnish energy and strength and build sound flesh, 
rather than those that serve merely to cater to the appe- 
tite or those that make soft fat. Just as the victim of 
tuberculosis is often a nervous individual with a change- 
able, capricious disposition, so his stomach* is apt to 
be extraordinarily sensitive and irritable; his fickle 
appetite calling for many favors, which should not be 
granted. For these reasons, rich food, nicknacks and 



* Here, and in certain other places in this book, the word 
stomach is used in a figurative sense, to avoid the frequent repe- 
tition of the more cumbersome term, digestive organs. 



THE SECRET OF EATING TO WIN 225 

highly seasoned eatables, whose tendency is to cause the 
digestive organs to rebel, are to be avoided as a rule. 
Altho plain food is not so toothsome, it is of ttimes a pre- 
ventive of serious trouble. (Later in this lesson there 
will be given a list and description of the more im- 
portant foods that count.) 

In addition to the two basic rules just discussed, other 
important guides for eating include: 

3. Always Respect the Feelings of Your Own 
Stomach. Bearing in mind that the digestive organs 
of no two individuals are exactly alike, let each person 
eat nothing that past experience has shown to be harm- 
ful to him, unless the evil effect be small and the need 
for the particular food great. In observing this rule, it 
is important to first make sure that one is not being 
governed by a whim or a mere dislike for a certain food. 
Again, a really valuable and highly important part of 
the dietary should not be put aside solely for the reason 
that it produces some slight distress of a temporary na- 
ture — a distress that is disagreeable rather than actually 
harmful. 

4. Eat Regularly and Eat Slowly. Many a person 
who, owing to a delicate stomach, has seen his chances 
fading, has forced the tide to turn in his favor and has 
finally won, by adhering firmly to this rule. Altho the 
first stomach was in use as early as the stone age, this 
organ has from the first adopted modern methods and 
has always demanded regular hours of labor. Through 
many generations the American stomach has held to its 
custom of working three times daily for a limited period. 
Unless false habits have been formed it is resting at other 
times, and is then not easily awakened to vigorous action. 
It is evident, then, that the average person should have 
his three " square meals' ' a day, at set intervals, which 
should be religiously adhered to. 



226 LESSONS ON TUBERCULOSIS 

The stomach demands further that the crude food ma- 
terial be previously properly prepared and supplied in 
such form that it can be digested in a reasonable time. 
This means that the food should not be bolted. Thorough 
mastication is an important preliminary to digestion. 
Plenty of time should be given to the meal, and the 
power supply of the digestive organs not diverted by 
distractive influences. To this end, reading or exciting 
conversations while eating should be avoided. In many 
instances, it is better for the ill person to eat alone at 
first. In other cases, it may be found that the invalid 
is more inclined to gulp down his food when alone than 
if he has company at the table. When this is true, the 
presence of other persons may be beneficial ; this is the 
more likely if he shows a tendency to brood over his 
troubles at meal-time — a state of mind which often re- 
tards the flow of digestive juices. 

5. The Dietary Should Contain All the Food Ele- 
ments in Suitable Proportion. In order to work most 
efficiently the body requires nutrient materials of all 
classes (which will be mentioned below), combined in 
fairly definite ratio. See to it, therefore, that your daily 
ration is properly balanced, and not a one-sided giving 
way to personal taste. 

6. Complicated Food Combinations Should Be 
Avoided. Altho food elements of all varieties are 
needed, this does not mean that the menu should consist 
of a combination of a large number of widely dissimilar 
items. It requires only the application of the law of 
common sense to see how unreasonable it is to expect 
the digestive organs to do good work when many dif- 
ferent duties are imposed upon them at one time. It is 
important, therefore, to make your menus as simple as 
possible. 



THE SECRET OF EATING TO WIN 227 

The Three Food Groups 

For practical purposes, foods may be divided into three 
groups, as follows : — 

1. Repair and Body Building Foods. These foods 
serve to enrich the blood, to build new tissue, and to 
make up for the daily wear and tear on the bodily ma- 
chinery. 

2. Fuel Foods. (Sometimes called quick fuel 
foods.) Foods of this class supply heat and power to 
the bodily engine. 

3. Reserve Foods. (Sometimes called slow fuel 
foods.) Reserve foods are stored in the body against 
future emergencies, when they are called upon to furnish 
heat and energy as required. 

The Food Ratio 

The average well person will have the best chance of 
retaining his health if his meals are arranged so that 
roughly from one-tenth to one-fifth of his daily ration 
consists of body building foods, the menu being com- 
pleted by the addition of members of the two other 
principal food groups, preferably combined in such a 
manner that the fuel group is represented in approxi- 
mately twice the amount of the reserve elements. On 
the other hand, as already intimated, the dictates of rea- 
son would lead one to presume that the sick person has 
need of additional food to repair the damage done by dis- 
ease; as a matter of fact, experience has demonstrated 
that the sufferer from tuberculosis often can increase, 
with benefit, his allowance of both the body building 
and the reserve foods from 25 to 50 per cent above the 
quantity required in health. 

If each individual will fix in mind the relative amount 
of each food group that is required, and select from each 



228 



LESSONS ON TUBERCULOSIS 



group such foods as agree with him, he will find that the 
knack of eating to win is easily acquired. 



BODY BUILDING 

MATEEIALS 

Proteins 

The important 

sources of proteins 

are: 

Lean meat 

Fish 

Milk 

Milk products: 

Cheese 

Custard 
Eggs (whites) 
The legumes 

Beans 

Peas 

Lentils 
Nuts 
Cereals (10%) 



QUICK FUEL 
MATEEIALS 
Starches and 

Sugars 

The important 
sources of starches 
and sugars are: 
Cereals 

Wheat 

Corn 

Oats 

Bice 

Barley 

Eye 
Cereal products: 

Bread 

Breakfast food 

Macaroni 

Spaghetti 

Noodles 

Dumplings 
Potatoes (Irish) 
Potatoes (Sweet) 
Corn 



EESEEVE FUEL 

MATEEIALS 

Fats and Oils 

The important 

sources of fats and 

oils are: 

Meat (fatty part) 

Bacon 

Butter 

Oleomargarine 

Cream 

Eggs (yolks) 

Olive oil 

Cottonseed oil 

(salad oil) 
Nuts (especially 

peanuts) 
Cocoanut oil 
Sesame oil 
Corn oil 
Peanut butter 
Soy beans 



IN ADDITION, THE FOLLOWING AEE FAIELY GOOD 

FUELS: 



Parsnips 


Carrots 


Artichokes 


Onions 


Turnips 


Spinach and other greens 


Beets 


Squash 


Sugar (hard to digest if eaten 


Apples 


in large quantity) 


Figs 


Honey 


Cherries 


Dates 


Pears 


Prunes 


Oranges 


Raisins and grapes 


Grape-fruit 


Bananas (somewhat constipat- 




ing) 





THE SECRET OF EATING TO WIN 229 

EDIBLES WORTH LITTLE AS TRUE FOODS 

But which have value from other standpoints (See text, pp. 236 
and 237). 

Vegetables Fruits 

Celery Peaches 

Lettuce Apricots 

Cucumbers Lemons 

Eggplant Especial Trouble Makers 

****&» Canteloup 

Cauliflower Watermelon 

£ abba f . Cucumbers 

TonSel * Cabbage 

Rhubarb 

LIFE REGULATING MATERIALS 

Vitamines 

The important sources of vitamines are: 

Milk, Cream The legumes 

Butter (not oleomargarine, ex- Vegetables (especially pota- 

cept insofar as it contains but- toes and the "greens") 

ter) Fresh fruits 
Cereals (coverings and embryo) 
Egg yolk 

(Note: The vitamines are injured by cooking.) 

The Life Regulators and Minerals 

In addition to their value as real foods — that is, as 
sources of tissue or energy — many of the things we eat 
contain a peculiar essence which, tho infinitesimal in 
amount, is nevertheless necessary to keep the stream of 
life flowing in orderly manner ; to regulate the growth of 
the body, and to prevent the development of scurvy, 
rickets and similar diseases. However, if a well mixed 
diet is eaten, one can hardly avoid incorporating in the 
daily ration some of these health-promoting principles or 
life-regulators, termed vitamines; so ordinarily little at- 
tention need be paid to them. Certain minerals are 
also very essential to the making of bone and blood, 



230 LESSONS ON TUBERCULOSIS 

but as these, too, are obtained in many different foods, 
they need be given only a passing mention here. 

For infants and children, however, whose menu is 
less varied, attention to the mineral and vitamine con- 
tent of the daily ration is highly important. This 
point — the question of providing the infant and child 
with sufficient vitamines — has been touched upon in 
Lesson III, p. 60, and the more noteworthy vitamine- 
containing foods will be named in describing the — 

Pros and Cons of Some Everyday Poods 
building and repair foods 

MEATS. Because meat holds so frequent a place on 
the bill-of-fare of the American people, this article of 
diet will be considered first. Let it be understood, how- 
ever, that this does not signify either that meat does, 
or does not, occupy first place in importance. The ques- 
tion whether or not meat is necessary to health, and the 
question of its relative value in comparison with other 
foods of this group, will be discussed a little later. Suf- 
fice it to say here that lean meat is one of the important 
body-building foods. 

Lamb and mutton are especially valuable, but beef, too, 
ranks high. On the whole, broiled steaks, rare tho 
tender roasts, and scraped raw meat sandwiches, yield 
perhaps the maximum value. Pork is digested with more 
difficulty than mutton or beef, and, with the exception 
of bacon, is the least satisfactory of the meats for fre- 
quent use. Fish and poultry are useful in varying the 
bill-of-fare, but are actually worth slightly less to the 
body than other meats. Turkey, chicken and rabbit 
are better foods than duck and goose. 

Those families to whom expense is an important con- 
sideration, should remember that veal — even "bob" veal, 



THE SECRET OF EATING TO WIN 231 

formerly looked upon with great disfavor, is now known 
to be at least a fairly satisfactory food.* It may be well, 
also, to emphasize the fact that the tougher, cheaper cuts 
of meat, if well cooked, are practically as easily digested 
and as nourishing as the choicer, more expensive parts. 

EGGS. Eggs are valuable tissue-builders and also 
furnish in their yolks a considerable amount of iron for 
enriching the blood. Eggs and milk hold a unique place 
among animal foods in that they are the only products 
of the animal kingdom that contain a certain amount of 
each of the basic food principles. 

Eggs may be taken in any form, altho it is well to avoid 
eating fried eggs frequently. Raw eggs, altho formerly 
much praised, are in fact in the average case probably 
less easily digested than if cooked ; furthermore, raw eggs 
sometimes upset the stomach, or produce diarrhea or 
other disturbance of the bowel, etc. Exceptionally, how- 
ever, they may be handled better than eggs in other form, 
and therefore be especially valuable. Then, too, there 
are cases in which, for reasons that are still somewhat 
obscure, a combination of raw egg, beaten with milk, is 
better taken care of than either milk or egg alone. 
Again, because of the ease with which they are swallowed, 
as a matter of convenience raw eggs occasionally become 
an important part of the dietary, in those less common 
cases in which forced feeding is desirable. It is remark- 
able with what agility the supposedly nauseous raw egg 
may be swallowed. If a small quantity of lemon juice 
be squeezed into a cup, the egg with the unbroken yolk 
dropped in, and a little more lemon juice added, the egg 
may be tossed down whole with no taste except of the 
lemon — and the trick is ended almost before one knows it. 

When cost is a large factor, eggs preserved in water 

* So too, it may be worth mentioning that horse meat is an 
excellent food, and in time of meat scarcity may be used in place 
of beef with perfect impunity. 



232 LESSONS ON TUBERCULOSIS 

glass, or cold storage eggs (if the time limit of the law 
be not exceeded), may be eaten with safety. 

MILK. Milk is one of the best of all foods, both be- 
cause it contains a moderate amount of all the primary 
food elements (and vitamines) and because it is usually 
digested with ease and readily assimilated. Then, too, 
milk and eggs both contain a considerable quantity of 
valuable mineral matter, the percentage of lime being 
especially large. Lime, it is recalled, is very necessary in 
Nature's process of repair (described in Lesson VIII), 
and for this reason also, these two articles have a par- 
ticular value in tuberculosis. Unless there be an excel- 
lent reason why it should not be taken, in reasonable 
amount milk should be given a place on the food pro- 
gram of all patients. Ordinarily, one or two glasses 
taken with each meal are sufficient. 

If one has a dislike for milk, its taste may perhaps be 
made agreeable by the addition of Vichy water or coffee, 
or by dropping in a pinch of salt or baking soda. If 
there is difficulty in its digestion, the milk may be diluted 
one-half with water or modified by adding a teaspoonf ul 
or more of lime water to each glass. Again, it may be 
mixed with malted milk, or with one of the prepared in- 
valid foods, such as Dennos', Eskay's, Nestle 's or Mel- 
lin's foods. Sometimes the stomach will tolerate hot 
milk when it rebels against cold milk. However, milk 
should not be heated except for a good reason ; for while 
hot milk is more readily digested than raw milk, it has 
the drawback of being more constipating.* 

In other cases, if one has an aversion to sweet milk, or 
if it causes distress, koumiss or one of the artificially 
soured milks — resembling buttermilk (which are less con- 
stipating than sweet milk) — may prove agreeable. 

• Moreover, heat injures or destroys the vitamines in the milk. 
This factor, however, has less bearing in the case of the adult, 
whose more varied bill-of-fare provides other vitamine-contain- 
ingr foods, than during- infancy and childhood, when milk is the 
mainstay of the dietary. 



THE SECRET OF EATING TO WIN 233 

The prepared sour milk should be made each day from 
fresh sweet milk by adding first a little water and then 
a culture of the true lactic acid bacillus (the Bulgarian 
bacillus), allowing the mixture to stand a number of 
hours according to the directions on the package. Vari- 
ous preparations of the Bulgarian bacillus are on the 
market, some in dried or tablet form, others liquid. The 
liquid cultures are the more reliable, altho the dried 
products are fairly satisfactory and more convenient. 
Milk modified in this manner is very palatable and is 
better than genuine buttermilk, not only because the lat- 
ter contains virtually no butterf at, but because true but- 
termilk often does not contain the genuine Bulgarian 
bacillus, and also is liable to be contaminated by harm- 
ful germs. 

In still other instances, the difficulty may be gotten 
around by partially predigesting the milk. All that is 
necessary for preparing the milk in this manner is to 
buy some " peptonizing' ' powder of the druggist, and 
follow the directions enclosed. 

Goats' milk agrees with certain stomachs that will 
not tolerate cows' milk. Goats' milk is unusually rich, 
and has the additional advantage that it seldom serves as 
a medium for spreading the germs of tuberculosis, as 
goats rarely contract this disease. 

Worth Remembering. In regard to the taking 
of milk, one final point deserves careful attention. The 
multiplied lessons of experience have shown that when 
milk disagrees, it often does so chiefly because it is 
hastily swallowed, and perhaps gulped down, a glassful 
at a time. Whether or not it is an advantage for all 
persons to drink milk very slowly, is, strange to relate, 
unsettled. But when the stomach has once manifested 
a violent antipathy to this valuable food, matters can 
usually be materially improved if one will cultivate 



234 LESSONS ON TUBERCULOSIS 

the habit of taking the milk in small sips from time 
to time, taking, say, a half hour to consume a glassful. 
Before concluding that it is necessary to eliminate milk 
from the bill-of-f are, this plan should be given a thorough 
trial. 

Milk products, such as custard, junket, cottage cheese 
and other cheeses, are all highly nutritious, and may be 
used to relieve the monotony of the menu. 

Ice Cream and Ices. Patients often inquire whether 
or not ice cream is a good food. In the first place, ice 
cream is to be looked upon as a rather concentrated 
form of cream and egg (or cream, milk and egg). In 
other words, in eating ice cream one is really getting a 
large amount of nutriment ; but is at the same time run- 
ning some danger of upsetting the stomach through put- 
ting into it so concentrated or rich a food. In addition, 
the very coldness of the dish tends to delay digestion 
and invite trouble. All in all, however, the power of 
ice cream to work injury is quite generally exaggerated. 
As a matter of fact, in the average case, if not over-in- 
dulged in, ice cream is frequently useful to round out 
and break the sameness of the menu ; at the same time it 
adds materially to the food value of the meal. Sherbets, 
ices and similar preparations, contain more water and 
less nutriment, and are accordingly of less value. 

THE LEGUMES. Peas, lentils, and beans of all 
varieties, stand high as building foods and are useful 
as meat substitutes if not used too frequently. It is 
unfortunate that these foods, especially beans, have the 
disadvantage of resulting in much gas-formation, this 
being very troublesome to some persons. This dis- 
tressing feature can, however, be obviated in part by 
adding a small amount of baking soda to the water in 
which the beans are first boiled, later pouring the liquid 
off and continuing the cooking process in fresh water. 



THE SECRET OF EATING TO WIN 235 

Those who are troubled with gas-formation or who find 
themselves sleepless and tossing about at night after 
having eaten beans at the mid-day or evening meal, 
should bear in mind that the best time to serve beans 
is at breakfast. 

In regard to string beans, it should be mentioned that 
the hull is largely waste material; it is the bean itself 
that is the really valuable part. 

NUTS. The various nuts are also important meat- 
sparers, but, as a rule, should be eaten only in limited 
quantity, as the digestive organs of most persons handle 
them well only in moderation. Nuts will probably be 
cared for to the best advantage if made one of the items 
of the lightest meal of the day — a meal from which 
meats should preferably be excluded or eaten only in 
small amount. 

THE CEREALS. The cereals also yield a small or 
moderate, tho definite, quantity of protein, and for this 
reason are to be included among the body-builders, 
altho they hold an even larger place in the fuel food 
group. 

FUEL FOODS 

CEREALS. That the term " Staff of Life," as ap- 
plied to bread, is appropriate, has been amply proven by 
time and experience. If bread is made to read cereals, 
the name is even more suitable. As a class, the cereals 
are the body's most valuable source of fuel, wheat and 
corn holding highest rank. The cereals are richer in 
starch than any other foods — about 75 per cent — and it 
is to this large starch content that they owe their worth 
as fuels. They may be served in flour products, as 
breakfast foods, or in the shape of macaroni, spaghetti, 
or noodles, or in some other manner, but in whatever 



236 LESSONS ON TUBERCULOSIS 

form taken, the cereals should make up a large part of 
the dietary.* 

VEGETABLES. Considered as a whole, the vege- 
tables constitute the second great source of fuel. Pota- 
toes, both white and sweet, stand highest on the list. If 
corn be placed in the vegetable group, it too should be 
given a prominent position. 

Other vegetables of less, tho moderate, value include : 
parsnips, artichokes, turnips, beets, carrots, onions, 
spinach and other greens, and squash. 

A third class of vegetable supplies considerable bulk 
and filling, but only a relatively small amount of actual 
nutriment. Embraced in this group are: tomatoes, 
celery, lettuce, cucumbers, cabbage, Brussels-sprouts, 
cauliflower, asparagus and rhubarb. The incorporation 
of a reasonable quantity of these vegetables in the daily 
ration is usually desirable, to supply their quota of 
minerals and vitamines, to give residue to the bowel 
contents, or to add piquancy to the meal, yet the fact 
should be kept before one that in eating these things one 
is getting little food value. 

One member of this group of vegetables, cabbage 
(when cooked) is digested with difficulty by many per- 
sons, and results in the formation of much gas. Ordina- 
rily, it should be eaten infrequently, or banned from the 
table. If admitted to the menu, cabbage will be less apt 
to cause distress if boiled only a short time (say, twenty 

* In addition to supplying a large amount of energy to the 
body, the cereals are useful in another way. When one eats the 
various grains, the undigested residue of their outer coverings 
lags behind in the bowel, this "roughage" serving to give bulk to 
the fecal mass, to retain moisture, and to spur the intestines 
on to better work, thus facilitating regular evacuations. For 
those who suffer from a delicate stomach, however, this or- 
dinarily good quality becomes a detriment — the coarser grain 
coverings serving to irritate the stomach lining, and to aggravate 
the trouble. In this event, it is usually best to eat only those 
cereals from which the outer hull has been removed. When the 
stomach and bowels both refuse to do their duties, the lesser of 
the two evils should be chosen; this means as a rule that the 
stomach and upper intestine should be supplied with the mild, 
easily digested foods that they demand, and other means em- 
ployed to conquer the constipation. 



THE SECEET OF EATING TO WIN 237 

to thirty minutes) . Raw cabbage, as in the form of slaw, 
ordinarily produces no ill effects. 

Thus an important point, applying to all foodstuffs, 
is brought out : Faulty preparation of the food is often 
the cause of trouble, rather than the article itself. 

Caution. Do not indulge in too many kinds of 
starches at one meal. True, many of us may thus 
transgress daily for years and years without harm result- 
ing, but it may usefully be remembered that when 
starchy foods disagree the dietary obstacle can often be 
gotten around by taking this simple precaution. For 
example, if potatoes and a cereal in some form, such as 
macaroni, are served, it may be best to leave out bread. 

SWEETS AND FRUITS. Sugar yields a large 
amount of energy ; in fact, sugar is turned into energy 
and strength with extraordinary rapidity. Nevertheless, 
sugar is well tolerated only in limited quantity, especially 
if taken in concentrated form. For this and other rea- 
sons it is well that it be taken mainly in its natural form, 
as occurring in honey * and fruit. 

Tho useful as laxatives and for their mineral and 
vitamine-content, if eaten in reasonable quantities, yet 
classed as a whole, fruits are poor in nutriment. A few 
fruits, however, contain a considerable quantity of either 
sugar or starch, and therefore have a larger food value. 
This group of more useful fruits embraces : dates, prunes, 
raisins and grapes, figs, cherries, bananas, oranges, grape- 
fruit, apples and pears. 

BESEBVE FOODS 

The reserve foods comprise the fats and oils. It is a 
common tendency for those afflicted with tuberculosis to 
discard the fatty portions of meat. This is a mistake. 
For while the taking on of a large amount of surplus 

* Like all generalizations, this one has its exceptions, for 
honey disagrees decidedly with a few persons. 



238 LESSONS ON TUBERCULOSIS 

fat is not only undesirable but liable to be definitely 
hurtful, yet the sufferer from this disease does on the 
average require a little more fatty food than the well 
person, a need which meat fat helps to fill. Milk, butter 
and cream, are also among the best means through 
which the necessary amount of fat may be obtained. 
Then too, the fact that oleomargarine is, for adults at 
least, virtually as healthful a food as butter, may be 
worth considering. * 

Olive oil, or the cheaper cotton seed oil (salad oil), 
which is equally healthful, taken on salad or swallowed 
with a pinch of salt, may be used to lend variety to 
the menu. Many nuts have a large oil content, peanuts 
and peanut butter being particularly valuable in this 
respect. If eaten in great quantity, however, nuts are 
apt to disagree. Among the ordinary vegetables, the 
soy bean is the only one worthy of note as a source of 
fat. 

Cod-liver OH. Patients often inquire concerning 
the value of cod-liver oil. This oil has the advantage 
of ease of digestion and assimilation, and also has a 
high vitamine content. It therefore ranks as one of the 
useful reserve foods. Whether or not it has any other 
beneficial quality is undecided. Exceptionally the 
administration of cod-liver oil is of considerable benefit, 
but ordinarily the other reserve foods mentioned serve 
the purpose equally as well, are less disagreeable to the 
taste, and are cheaper. 

Food and Fever 

The old maxim that one should "starve a fever" does 
not usually hold good in tuberculosis. Based on the well 
known observation that during fever the ability of the 



* Oleomargarine is however deficient in vitamines; therefore, 
if possible, butter should be fed to children, who have most need 
for these vital principles. 



THE SECRET OF EATING TO WIN 239 

body to care for and make use of food is inclined to fall 
below par, this time-worn saying contains more than a 
grain of truth ; but it is also to be remembered that the 
fire of fever burns up the tissues of the body rapidly 
and wastes its store of fuel, so that the actual need for 
both fuel and repair material is increased. Both of 
these facts must be given due weight by the sick person 
in solving his own problem. In this connection, one point 
deserves special mention. When attacked by some acute 
febrile disease of short duration it often proves wise to 
curtail one's dietary to a considerable extent. In tuber- 
culosis, however — a disease whose course is commonly 
long drawn out — the matter has a different aspect. 
One cannot " starve the fever" indefinitely without at 
the same time starving the patient beyond hope of recu- 
peration. In keeping with these deductions, when formu- 
lating a practical guide for oneself, one should endeavor 
to avoid both extremes. Expressed in a word: When 
fever occurs, if there be no marked evidence that the 
food disagrees, the ration should be a fairly large one, 
but the crippled organs should be spared as much as 
possible by eating food that is easily digested. 

Be the cause fever or what it may, at some time or 
other during the illness, very probably there will arrive 
a period when some one of the digestive organs (for ex- 
ample, the stomach or the bowel) refuses longer to work 
properly. Coming at a time when the general condi- 
tion is often critical indeed, the rather natural tendency 
is to attempt to force even more work on the rebelling 
organ. This is a mistake, and may only serve to make 
the strike a complete one. As a rule, if the food supply 
be temporarily cut down, the distressing period will be 
tided over, and in a short time the organ will probably 
resume its normal functions. In some instances it is 
wise to give the stomach and bowel a complete rest for 



240 LESSONS ON TUBERCULOSIS 

a day or two. It need not be feared that the cutting 
off of the rations entirely for this brief period will have 
serious consequences. If the results be carefully ob- 
served, one will usually see that the short time lost has 
been paid back with interest through increased efficiency. 

The Appetite's False Signals. Someone has said 
that "hunger is the best sauce," and certain persons, tak- 
ing the appetite to be an infallible signal indicating 
accurately the needs of the body, firmly believe that one 
should eat only when hungry, and only those foods that 
the appetite desires. Probably at one time hunger was 
Nature's sign that more food was required, and the ab- 
sence of hunger signified with equal accuracy that no 
food was needed ; yet it is only necessary for one to be 
seriously ailing oneself in order to realize what a serious 
error it would be to accept the appetite as a reliable 
guide. Many a decidedly sick person would have liter- 
ally starved to death if he had trusted to his appetite, 
which totally failed him at a time when his actual need 
was urgent in the extreme. Concretely applied, this 
means that he who is desperately ill must ofttimes make 
himself eat, even tho the very thought of food is 
repugnant. Of course it is not wise for him to over- 
load his stomach ; but if he is to recover, his body must 
be supplied with sufficient food and power material at 
all times to keep the machine running. 

Here let a mental memorandum be made of the fact 
that the taking of a moderate quantity of food in the 
absence of the hunger-urge is not to be considered as 
forced feeding in the sense of the word "stuffing,'' which 
will be alluded to again later. On the other hand, owing 
to the ease with which in this extravagant age, one's 
desires may be gratified, the art of fastidious eating has 
led to the development of numerous highly perverted 
tastes. Often the appetite is unusually keen; it may 



THE SECRET OF EATING TO WIN 241 

then be necessary for one to leave the table while still 
hungry. Again, articles are desired that are entirely 
out of reason. Is it not apparent, then, that while per- 
sonal taste may be humored to as great a degree as is 
compatible with one's own true needs and capacities, 
the hunger-urge is never to be accepted as an entirely 
trustworthy guide to the requirements? 

Through training and watchfulness, however, a treach- 
erous appetite may be made more dependable. 

Appetite Invigorators. Notwithstanding the truth 
of the foregoing statements, the fact cannot be gainsaid 
that food eaten with relish is more likely to prove useful 
than if eaten merely because it is needed. Hence every 
means should be taken to encourage the appetite. The 
best appetite sharpener is the open-air life combined with 
regularity in eating ; but it should not be forgotten that 
the special senses also play an important role; that 
proper cooking and attractive serving of the food, plus 
a reasonable variation in the items of the meal, hold 
second place as stimulators of the appetite juices. The 
appetite of the invalid must sometimes be coaxed along 
for quite a period, and to this end no pains should be 
spared to prepare the food in an inviting and tasteful 
manner. A good cookbook should be kept at hand and 
consulted at frequent intervals. With this, and the 
use of a little ingenuity and forethought in daintily 
garnishing the dishes, a touch of newness may be given 
that will act as an efficient appetite promoter. In the 
end, little cares of this nature are often life-saving. 

With the same idea in mind, a moderate use of some 
of the edibles listed herein as worth little as true foods, 
may at times be made to fill what is then an important 
function — the awakening of a jaded appetite. Eelishes 
and spices such as mustard, Worcestershire sauce, vine- 
gar and condiments; as well as salads and soups — all 

16 



242 LESSONS ON TUBERCULOSIS 

worth little in themselves — through giving flavor and 
zest to the food serve to tickle the palate and so stimulate 
the flow of digestive juices that a call is created for 
better foods, which can then be eaten with pleasure. 
Among appetite teasers must also be placed beef extract, 
a preparation once highly vaunted as a food but now 
known to have little worth except as an agent for pre- 
paring the way for real foods. Tomatoes, too, have lit- 
tle true food value, yet rank high as appetite bracers. 
Altho these appetizers are worthy of use at certain times, 
if indulged in habitually or taken in excess the good 
effect is apt to be lost and direct harm may be done; 
so their use should be interdicted unless actually called 
for. 

On Skipping a Meal. As previously intimated, if 
you have lost much weight and are in urgent need of 
every ounce of food you can assimilate, it would be 
folly for you to wait idly for any length of time for 
your appetite to cry out for food ere you eat. Neverthe- 
less, if you have found it necessary to force yourself to 
eat if you eat at all, it may be worth while to occasionally 
omit one or more meals, hoping thereby to acquire a 
genuine desire for food. "It is better to eat yesterday's 
dinner than to-morrow's," runs the saying; and it is a 
fact that if you sit at table merely from habit or duty 
and dally with your food in a half-hearted manner, by 
skipping a meal or two now and then you may give your 
appetite an opportunity to catch up with your actual 
needs, and thus develop a genuine pleasure in eating. 
Caution: This plan is hardly practicable unless the 
body is at least fairly well nourished, so that it is safe 
to cut the daily ration temporarily. 

The Heaviest Meal. Patients often inquire which 
meal should be the heaviest. This is an individual mat- 
ter, depending partly on previous habit, on personal 



THE SECRET OF EATING TO WIN 243 

taste, and other variable factors. On the whole, the di- 
gestive organs work most efficiently after a fairly long 
rest, and when the bodily temperature is comparatively 
low; so for both reasons one should eat a hearty break- 
fast, thereby gaining a good start each day while the 
conditions are right. For patients whose fever is highest 
near the middle of the day, it is often an advantage if 
the heavier of the other two meals be taken at night. 
In other cases, the eating of a full meal at night inter- 
feres with sleep. Discretion must be used ; judgment in 
each case will settle the problem. 

Food on Hot Days. A related matter is the ques- 
tion of food for hot days. During summer weather the 
requirements of the body are less, and as the digestion is 
sluggish at this time, the amount of food can in many 
cases be slightly reduced with benefit. 

Fads in Eating. All sorts of dietaries, ranging all 
the way from fasting or the " starvation cure" to the 
M stuffing' ■ habit, have been recommended to those 
afflicted with tuberculosis. At one time the drinking of 
warm beef blood was highly praised ; now beef blood is 
looked upon as having little or no more value than fresh 
meat. A diet composed almost entirely of meat has had 
its advocates, while to-day meat prohibition, or "vege- 
tarianism," has many followers. On every hand some 
friend may have a special system of eating to recom- 
mend. To such persons the searcher for health should 
ordinarily turn a deaf ear, no matter how sincere their 
entreaties or how alluring the claims made for these 
one-sided bills-of-fare, which usually turn out to be 
merely traps for the unwary. 

Vegetarianism. That perfect health has been main- 
tained entirely without the use of animal food, and that 
certain persons live more healthful and happier lives if 
meat be excluded from the menu, has been definitely 



244 LESSONS ON TUBERCULOSIS 

established ; that others, both among the well and among 
the sick, have signally failed to thrive on similar rations 
is also undoubted. Neither of these truths furnish the 
answer to the question whether or not it is prudent for 
the average individual to omit flesh from his diet. 

In America, at any rate, through centuries of habit 
and training the body has acquired the ability to extract 
the substances that it needs most easily from a mixture 
of both animal and vegetable foods. Then, too, even most 
vegetarians lay stress on the value of a good appetite as 
an aid to digestion; in this connection how many are 
there who, at the outset or for quite a period, evince a 
real desire for purely vegetable foods or for a meatless 
dietary? Many never get over the primary feeling of 
distaste ; some stomachs permanently resist re-education 
along this line. Again, the selection and preparation of 
properly balanced menus of exclusively vegetable foods 
require considerable study and care, to which few will 
devote the time ; and without which such a dietary will 
probably prove worse than useless. 

As it is a poor plan to experiment during sickness, the 
common-sense conclusion is that, barring a valid con- 
trary reason, unless the sufferer from tuberculosis be 
under the immediate control of a physician who not 
only has a thorough understanding of tuberculosis but 
of vegetarianism as well— a rare combination — he will 
as a rule best serve himself by embodying in his dietary 
both animal and vegetable foods.* 

"Honor to Whom Honor Is Due." To the vege- 
tarian must be given credit for accentuating the dangers 
that lie in wait for those who habitually gorge themselves 
on meat or other protein foods, and for demonstrating 
conclusively that most of us could increase our chances 

* Persons previously accustomed to subsisting 1 on vegetable 
aliments alone, if their experience has proven that such rations 
agree with them, may continue to follow their ordinary custom 
in this matter. 



THE SECRET OF EATING TO WIN 245 

of living out our allotted span by lessening the amount 
of flesh and other proteins we consume. 

In suitable quantity protein foods are vitally neces- 
sary, but if taken in so great an amount that other foods 
are slighted, virtually only one of the needs of the body 
will be satisfied. Above all else, proteins are repair 
foods — builders of muscle and brawn ; they do not fur- 
nish in sufficient amount the energy and power which 
is just as pressingly demanded. In addition, the over- 
loading of the stomach with such one-sided rations fre- 
quently leads to the accumulation of poisons that not 
only account for many disagreeable sensations, such as 
headache, a feeling of logyness, and bowel distur- 
bances, but which tend to produce in time serious disease 
of the kidneys, the circulatory system and the liver. 

Another Common Transgression. Another common 
mistake is eating too much fruit and the more tasty 
vegetables, that serve well as " trouble makers" but con- 
tain little nutriment. Unfortunately the season for 
fresh fruit and green vegetables arrives just at the time 
when the stomach and bowels are, due to the hot weather, 
in ripe condition for an upset. Remembering the in- 
junction that less heavy food is required during summer 
weather, certain patients are prone to overload the 
stomach with cantaloups, peaches, apricots, tomatoes, cu- 
cumbers and the like, at the expense of the digestion. A 
little fruit is ordinarily beneficial; but an excess, espe- 
cially during hot weather, is often worse than a full gen- 
eral diet. Those who have an especial liking for fruits 
and for vegetables of this class or who place too high a 
faith in them, will do well to note carefully the fact that 
beyond their virtues as laxatives and as sources of min- 
eral matter and vitamines (and these effects and con- 
stituents are of course important), fruits in general 
and vegetables of this nature have little to recommend 



246 LESSONS ON TUBERCULOSIS 

them to a prominent place on the bill-of-fare. The 
habit of eating a large amount of this class of foodstuffs 
is only too often a breeder of serious trouble. More- 
over, persons who carry this idea to an extreme, wonder 
why they do not gain weight and why they suffer so 
much from gas, from nausea and vomiting, or from 
diarrhea. 

A Popular Misconception. How to Eat Fruit to 
the Best Advantage. The view is widespread that if 
fruit and cream are eaten together or if one drinks milk 
at the same meal, this may lead to some undesirable 
reactional disturbance in the stomach; furthermore, the 
same popular opinion tells us that if the fruit be eaten 
alone, or without the milk or cream, no disagreeable 
effects will occur. Investigations and experience, on the 
contrary, have proven that fruit and cream (or milk) 
rarely, if ever, form a harmful combination in the 
stomach, and have shown that the belief just cited is 
as a rule a myth, pure and simple. As a matter of fact, 
a meal made up altogether, or chiefly, of dairy prod- 
ucts — such as milk, cream, cheese, junket, eggs, etc. — 
plus fruit, is perhaps the ideal way to eat fruit. 

True, difficulty sometimes arises following a meal in 
which fruit and milk, or cream, have been included. 
In this case the tendency is to take for granted that 
these items have been the cause of the difficulty; 
whereas the real source of the trouble is overlooked 
entirely. Usually it is the starchy food of some variety 
incorporated in the same bill-of-fare that must shoulder 
the blame. 

For example : Let fruit and one or more dairy products 
be combined and no disturbance is produced. Add 
bread, a breakfast food, potatoes, or a generous slice of 
cake to this menu and, if the stomach is inclined to be 
sensitive, at once difficulty is experienced. Or let merely 



THE SECRET OF EATING TO WIN 247 

the starch and fruit be combined, and trouble is liable 
to arise. Thus it is shown that the starch-fruit com- 
bination is often the unsuspected source of difficulty, 
not the cream or milk-fruit combination. The reason 
is this: Most fruits contain quite a bit of acid, which 
has a tendency to retard the digestion of starch (which 
requires an alkaline or neutral medium for its digestion) 
and to permit fermentation. 

If it is impracticable to omit starches altogether from 
meals during which fruit is eaten, the ill effect may be 
minimized by selecting fruits that contain a relatively 
small quantity of acid, such as ripe, mellow apples, pears, 
peaches, etc. ; reserving the more acid fruits for lunches 
between meals. 

All in all, fruit will probably be cared for to the best 
advantage if partaken of at one of the lighter meals 
of the day — a meal in which dairy products have the 
most prominent place. Preferably, only one variety 
of fruit should be eaten at one meal. CAUTION : In 
carrying out this plan, if you are in urgent need of all 
the food you can assimilate, you should be careful not 
to cut the other and more nutritious items of the * 'fruit 
meal" below the safety limit. Let it be understood, 
also, that the remarks under this head are not to be con- 
strued as definite and absolute rules: their main pur- 
pose is to correct a popular fallacy and to suggest the 
way for each individual to work out his own dietary 
problem. 

The "Milk Cure." Some there are who, appre- 
ciating the immense food value of milk, attempt to live 
on it alone. This, too, is an error. For while milk is an 
excellent food and contains all the food elements, these 
ingredients are not present in the proportions required 
by the body; so milk is not satisfactory as the sole 
source of nourishment, save under unusual and special 



248 LESSONS ON TUBERCULOSIS 

circumstances. In order to obtain a sufficient amount 
of one constituent one would necessarily acquire an ex- 
cess of another; further, so much milk would be called 
for that the capacity of the stomach and other organs 
to handle it would be severely and perhaps over-taxed. 

The Pacts of the Case. While it is perfectly true 
that most of these so-called fad dietaries are useful when 
exceptional conditions are present, if used for a limited 
time and for a definite purpose only, the ordinary 
tendency is to make one or the other of them a hobby, 
which is ridden till serious consequences ensue. Hence, 
in all cases before launching upon a one-sided diet of any 
nature, one would do well to consult a physician well 
informed both upon food values and tuberculosis. 

The " Stuffing' p Evil 

Stuffing the Body Like Overcrowding the Furnace. 

Since it was learned years ago that by eating an amount 
of food well above his normal requirements, the con- 
sumptive could often obtain a rapid and pronounced 
increase in weight, the practice of forcing the diet of 
the pulmonary invalid has become common. Despite 
the fact that " stuffing' ' has been shown to lead to 
catastrophe much more frequently than it has proven 
of benefit, the plan is unfortunately still in fairly wide 
use to-day. Lest the sufferer, reaching out for a support, 
find to his sorrow that overeating is merely a straw 
which gives way beneath him, it is necessary to state in 
as forcible a manner as possible, the warning: Do not 
exchange your chances, perhaps your only chance, of 
complete restoration to health, solely for a gain in 
weight — a mere improvement in appearance, which may 
but mask the progress of your malady until it is too 
late. 
A Lesson from Experience. To all who have ob- 




OLD AND NEW RATIONS 

Formerly it was customary for persons afflicted with tuberculosis to 
stuff themselves in order to grow fat, as exemplified by the upper dietary 
photo with its between -meal luncheons. The lower photo shows a meal 
composed of the various food groups in generous quantity but without 
overfeeding — the common-sense ration. 



THE SECRET OF EATING TO WIN 249 

served closely many patients who have followed the 
plan of forced feeding, the moral is plain. If one has 
seen the pale, lean, haggard consumptive compel him- 
self to swallow three large meals a day, and force down 
a glass or two of milk and several raw eggs after each 
meal, besides consuming additional quantities of milk 
and eggs between meals and at bedtime ; if one has seen 
the gaunt, lean frame begin to fill out a little, and noted 
how the invalid's emotions changed from discourage- 
ment to joy as his body rounded out with flesh, until 
on casual inspection he appeared well and strong; if 
one has meantime observed how this brightened outlook, 
combined with the moderate abatement of his symptoms, 
have not only caused the individual to actually feel 
well, but have firmly implanted in his mind the belief 
that he has permanently conquered the plague: after 
this remarkable change has occurred, if one has noted 
how excessive optimism has led the victim to lessen his 
efforts in other ways, to over-exercise when he should 
be resting, and to do many other harmful things ; if one 
has remarked how this continued overtaxation of the 
capacities has in turn at last caused the invalid's 
stomach, his heart, kidneys, or other organs to give way 
under the strain, and has seen how through the effect 
of one or more of these influences, the soft, flabby fat has 
rapidly melted away, until he has reached a condition as 
bad or worse than before, while the feeling of elation 
and great gladness has changed to hopelessness, to lack 
of faith and despair — if one has witnessed these things, 
not once but many times, no further evidence will be 
needed to convince one that forced feeding is a danger- 
ous remedy.* 



* Forced feeding also violates the principle of functional rest. 
For each additional ounce of food eaten, the greater must be the 
supply of oxygen, which makes it necessary for the patient to 
breathe deeper or more rapidly. As it is just as important to 
obtain relative respiratory rest as it is to obtain muscular and 



250 LESSONS ON TUBERCULOSIS 

Is Forced Feeding Ever Advisable? Altho these 
things emphasize that it is necessary for each individual 
to guard himself to the utmost against stepping into this 
pitfall, yet they are not intended to carry the meaning 
that a diet above the average amount is never of value. 
If one keeps in mind that weight alone is virtually use- 
less, and looks upon it as only one indicator, or, at best, 
as merely a means to the end ; that weight above a rea- 
sonable amount is just so much excess baggage to be 
carried around, which serves only to make the heart and 
other organs perform needless work — then and then 
only, in certain cases (usually only when other methods 
have not proven satisfactory), the diet may be cautiously 
extended in moderation provided the effect be carefully 
watched and the extra food be taken for a limited period 
only. The rapid development of the outward veneer 
of health under this regimen is quite encouraging to 
the one who is sick ; but it should not be forgotten that 
a relapse due to excessive enthusiasm and overdoing, 
may mean failure. In those exceptional cases where 
the procedure seems justifiable, before putting the 
plan into operation, one should fortify oneself well 
against falling a victim to the false feeling of security 
Which will almost inevitably come later. 

When it appears profitable to force the diet, the tak- 
ing of an extra glass of milk or two, or its equivalent, 
and one or two raw eggs — between meals — and perhaps 
also a similar lunch at bedtime, is a convenient way of 



mental rest, in eating the endeavor should be to strike a balance 
between the repair requirements and overwork for the lungs. 
X*ater, as the disease becomes quiescent, the quantity of food 
may, if necessary, be increased to meet the muscular needs. 
1 do not wish the impression to be gained, however, that 
unhappy results always accrue when overeating is practised. 
Even when this plan is pursued indiscriminately or haphazardly, 
in many cases no great damage will be done. On the other hand, 
serious consequences (consequences that, in the long run for 
one reason or another, are aften responsible for death) occur in 
eo many instances, following the execution of this apparently 
simple and innocent procedure, that it is essential for one to 
be forewarned of the hidden dangers. 



THE SECRET OF EATING TO WIN 251 

accomplishing the purpose. One glass of milk and one 
egg for the lunches will be sufficient in most cases. The 
bedtime lunch should be omitted in all but the most 
stubborn. Some persons digest the milk and eggs more 
readily if they are made into a sort of egg-nog. In 
making this drink, the egg should be beaten separately, 
making sure that no free particles that may cause 
gagging, remain; then placed in the milk, the whole 
beaten again, and a little seasoning such as nutmeg 
or cinnamon added, if desired. If, however, the milk 
and eggs taken in this way disagree, perhaps produc- 
ing fermentation or diarrhea, they may be prepared in 
some other manner,* or other additional food taken, 
the aim being to add the least amount that will serve 
the purpose. 

A Happy Result from a Restricted Diet. Persons 
who have been crowding their diet, but who find them- 
selves still stationary in weight, or even losing, may take 
heart by bearing in mind that the coveted flesh may 
sometimes be obtained by cutting down in reasonable 
degree their allowance of food, and by heeding the other 
rules for eating mentioned herein. I have frequently 



* Digestion of the milk-egg combination may sometimes be 
facilitated by adding two hundred and forty drops of dilute 
muriatic (hydrochloric) acid to each quart of the mixture, after 
which it is again stirred well or thoroughly beaten. 

IMPORTANT: Note that the dilute acid is used, and before 
making concrete application of the plan, two points should be 
given careful attention: (1) Now and then a stomach is met 
with that is already over-supplied with hydrochloric acid. 
(2) The dose of the acid suggested above is several times larger 
than ordinarily prescribed. For these reasons it is imperative 
that it be made reasonably certain (preferably through counsel 
with a physician) that there is no factor in your own case 
that may make so large a dose unsafe. If previously one has 
been troubled with turning in the stomach, this indicates the 
presence either of (a) an excess of the normal hydrochloric 
acid or (b) the presence of abnormal acids. In the latter case, 
the taking of hydrochloric acid may prove beneficial. In the 
former case it will only add insult to injury. Hence, in the 
absence of a physician, if burning is present the hydrochloric 
acid method is to be taken up very cautiously, if at all. In 
this case, only one teaspoonful of the acid should be used at first, 
or until assured that this does not increase the burning. 

If desired, hydrochloric acid may be used in the same manner 
to assist in the digestion of milk alone. 



252 LESSONS ON TUBERCULOSIS 

seen patients who were consuming large quantities of 
food with nothing to show for their efforts but indiges- 
tion, disgust and discouragement ; who, after putting into 
effect the suggestion that they eat less but eat properly, 
were overjoyed to find that by merely giving the di- 
gestive organs a fair chance to work within their 
capacities, they soon began to put on solid and sub- 
stantial flesh. In some cases weight was put on follow- 
ing even a quite marked restriction of diet. NOTE: 
The plan of reducing the intake of food below the 
standard amount is not, however, recommended unless 
there be good ground for suspecting that it will prove 
useful. 

Beverages 

Water is the safest and best beverage and, unless there 
be some reason to the contrary, should be drunk freely. 
In addition to the water taken in food, in health,* two 
quarts of water daily, either in the pure state or in 
some beverage, is required by the average individual. 
Ice-water delays digestion slightly; it should therefore 
be used sparingly or banned entirely, as occasion de- 
mands. 

Tea and coffee both contain the harmful astringent, 
tannin, and also respectively yield the identical drugs, 
thein and caffein; if used at all, they should be con- 
sumed in moderation. There are several preparations 

* There is sound basis for the belief that during fever not only 
is more than the ordinary quantity of water necessary, but that 
water drinking helps materially to lower the temperature of the 
body. In selected cases of acute illness copious amounts of 
water, often eight quarts daily, have been administered, with ap- 
parently very beneficial results. Altho in a long drawn out 
fever, as may occur in tuberculosis, the administration of large 
quantities of water is a different question, and the ability of 
the system to cope with or care for such quantities of liquid 
must be given careful consideration, nevertheless it is probable 
that more water could be taken by the average patient with 
benefit, and if the digestion is good, the stomach not dilated, and 
the circulatory system and kidneys fairly sound, during fever it 
may prove well worth while to cautiously gradually increase to 
a considerable degree the amount of liquids taken. 



THE SECRET OF EATING TO WIN 253 

of whole bean coffee on the market, such as "Dekoffa" 
and "Kaffee Hag/' from which the caffein has been in 
large part removed, which provide one way out for the 
confirmed coffee drinker. "Postum," "Drinket" and 
similar substitutes satisfy the craving of other persons, 
and are perhaps more preferable from the health stand- 
point. Chocolate and cocoa are less stimulating than 
coffee and tea, contain a greater proportion of nutri- 
ment, and are on the whole more wholesome beverages. 

An Error to Avoid. Much stress has been laid by 
some persons on the danger of water drinking at meal- 
time. It appears from recent investigations, however, 
that in the absence of digestive disturbance or a dilated 
stomach, little if any harm occurs. Nevertheless, if 
liquids are used to moisten the food so that it will slip 
down easily, an important function of the saliva will be 
defeated. Bear in mind that the saliva is one of the 
digestive juices, and that its intimate admixture with 
the food is essential ; so whatever liquid is partaken of, 
do not use it simply to wash down the food. 

When the stomach is known to be dilated or if distress 
follows eating, especially if vomiting occurs, it is often 
an advantage to take the meals dry and to take the 
liquids say an hour before eating. 

What About Alcohol? Frequently the question is 
asked whether some mild alcoholic drink may not be 
taken in moderation with good effect. In some degree 
alcohol furnishes energy to the system, and therefore 
ranks as a food-sparer ; it sometimes serves to whet the 
appetite and to invigorate a sluggish digestion, and in 
certain instances it may do good in some other man- 
ner. On the other hand, it is now a well recognized 
fact that alcohol decreases the resistance to almost all 
diseases, including tuberculosis ; further, all persons who 
use alcohol run some chance of contracting the habit; 



254 LESSONS ON TUBERCULOSIS 

again, even a small drink tends to so mask the sensi- 
bilities of the patient that for the time being he feels 
much stronger and better, and is liable to do imprudent 
things. 

In conclusion, it may be said that the good effect of 
alcohol can usually be obtained in a safer and better man- 
ner by the use of some other agency, and that if carelessly 
used the harm is almost sure to overbalance the good. 
If taken, alcohol should be considered a medicine, and if 
used for its effect on the appetite and digestion should 
be taken before or during the meals, preferably in the 
form of a glass of beer or ale, or malt extract or one of 
the milder wines. 



LESSON XI 

THE ELIXIR OF HEALTH, FRESH AIR— ITS USE 
AND ABUSE 

Who has not at some time felt the call of the great 
outdoors, and sought recuperation through a longer 
or shorter sojourn in this enchanting realm of Nature? 
Do you who have responded to the summons recall how, 
perchance, your appetite was so sharpened after a few 
days spent in the open, that you could hardly wait for 
the food to thoroughly cook ; and how the coarse edibles, 
seasoned with the spice of the outdoor air, seemed the 
choicest of viands? Do you remember how your ner- 
vousness left you, and your surprise at finding your- 
self sleeping soundly on the hard, rough bed, right next 
to Mother Earth? No doubt you recollect how delight- 
fully fresh you felt, how keenly invigorated and ex- 
hilarated by the tang and sting of the cool biting air; 
how full you were of energy and vim — in fact, so strongly 
imbued with the zest of life that you just knew that 
every organ in your body was getting back on the job ! 

Yes; and how you became hardened and toughened 
till you could hardly believe it was really you, who had 
developed into this brawny, red-blooded individual who 
could withstand rigorous exposure, violent changes of 
temperature, drafts and dampness, without harm re- 
sulting. How astonished you were to discover that you 
no longer picked up every "cold" that came along, but 
now enjoyed a remarkable freedom from these infections 
to which you had formerly been so susceptible! 

255 



256 LESSONS ON TUBERCULOSIS 

Pleasant memories of outdoor excursions of this sort 
are cherished by nearly everyone. Yet how many there 
are who fail to apply in their everyday lives the lesson 
drawn from these experiences ! Yet if wisely indulged 
in, the outdoor life brings to the victim of tuberculosis all 
the blessings enumerated above, and even more. 

The Right and the Wrong Use op Open Air 

The open air treatment of tuberculosis has been in 
use for three-quarters of a century, time having con- 
clusively proven that the early confidence placed in the 
method was entirely warranted. Notwithstanding the 
many merits of fresh air, however, it remains a sad fact 
that an erroneous interpretation of the term, outdoor 
living, as applied to tuberculosis, has led frequently to 
abuse of this valuable remedy and to a consequent 
and needless sacrifice of untold numbers of lives. In 
order to make sure of obtaining the maximum benefit 
from this one of Nature's remedies, it will be well at 
the outset, therefore, to see what has been the cause of 
so costly an error. 

Outdoor Living Does Not Mean Roughing It. Be- 
cause the words "The Great Outdoors' ' are in some 
quarters indelibly associated with the idea of continual 
wandering in Nature's broad dominion, the belief is 
still widespread that simple living in the open is 
synonymous with roughing it. It is true that in rare 
instances persons suffering from tuberculosis — some even 
in an apparently hopeless condition — leaving civiliza- 
tion behind, have sought, and at last found health, tho 
living under very trying and unfavorable conditions, 
in some wild, rough country. There, living constantly 
under the sun and stars, drifting about from place to 
place, subjecting themselves to physical strain, some- 
times suffering the pangs of hunger, of thirst, and under- 



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ELIXIR OF HEALTH, FRESH AIR 257 

going other deprivations — nevertheless they have finally 
emerged into the world with their formerly wasted 
bodies now filled out and glowing with health — once 
again real men and women.* 

Persons who have obtained the prize in this way usually 
cannot say enough good things of "getting close to na- 
ture/' and "roughing it"; and speak with inspiring 
fervor of their experience, urging others among the 
afflicted to do likewise; not realizing that to the great 
majority they preach only — disaster. 

What of those others who follow in the footsteps of 
the more fortunate? Here and there an exceptional 
individual returns, triumphant; but at least nine out 
of ten succumb to the too heavy demands upon bodies 
already crippled and weighted down with disease. Home- 
sickness, despondency, scarcity of good food, over-exer- 
tion and exposure, write the story of wrecked hopes. 

The exceptions serve only to emphasize the rule that 
hardships and exposure have no place in the rational 
application of fresh air to active tuberculosis. To say 
that roughing it has shattered the last chance of thou- 
sands upon thousands tells only half the tale. 

Can you afford to take the gambler 's chance ? Are you 
willing to stake all, on less than one chance in ten ? Or 
do you not believe it is better to stick to the method that 
has proven best for the great majority ? Altho the out- 
of-doors is Nature's boon to the sufferer from tubercu- 
losis, one should never let slip the fact that the 



•For such persons the mental rest obtained through lelease 
from the trials and worries of business and perhaps from the 
cares of the home, the feeling" of faith or at least revived hope 
awakened by stepping" into the unknown, the complete change in 
habits and environment, the bracing effect of the clean fresh 
air, the stimulating odor of the outdoor verdure, the new sights 
greeting the eye and the other attractions of the free life under 
Nature's canopy — and in some instances the change to a more 
salubrious climate — some or all of these things, or similar in- 
fluences have been sufficient to outweigh the injurious effect of 
over-exertion, exposure and the like, and to restore them to 
rugged health. 
17 



258 LESSONS ON TUBERCULOSIS 

administration of fresh air must be accompanied by a 
generous dose of common sense, and that it is essential 
for the rest treatment to be carried out at the same 
time. True, Nature is the great restorer, but even 
Nature must be given a chance. 

The Effect of Fresh Air 

Before examining the rules that govern the use of 
fresh air, it seems advisable to spend a little time in 
ascertaining just how the good effect of outdoor living is 
brought about. At first sight a consideration of this 
matter may appear technical rather than practical — 
hence, unnecessary. If, however, one will show a spirit 
of forbearance and patience while reading the next few 
pages, for the purpose of learning a little of the how 
and why of fresh air, later when the knowledge gained 
is translated into definite and effective action, thus ex- 
tracting from fresh air the whole kernel of its value, one 
will see that the little preliminary study has been well 
worth while. 

Original Conjecture versus Modern Proof. During 
the last decade or two the conception of the effect of 
outdoor living has undergone a radical change. Early 
ideas and notions, based almost solely on surmise and 
assumption, under the searching light of science have 
been blotted from view, giving place to a new and more 
accurate understanding — an understanding built upon 
the solid foundation of proof yielded by numerous pains- 
taking investigations. 

This statement demands the immediate and forcible 
qualification that the discovery that the old inferences 
were in many respects faulty and are no longer ten- 
able, casts not even a miniature cloud on the value 
of outdoor living, whose usefulness is beyond dispute. 

The questions are often asked, What is meant by 



ELIXIR OF HEALTH, FRESH AIR 259 

"fresh air"? and, To what properties does fresh air owe 
its good effect? The answer to these questions cannot 
in its entirety be made offhand. In one phase, how- 
ever, the answer can be promptly and concisely stated : — 

Fresh Air Contains a Minimum Number of Germs. 
Due to the diluting effect of the continual intermixing 
out-of-doors of the impure air with the pure air, and to 
the germ destroying action of sunlight, air fresh from 
the outside is comparatively free from germs of all 
varieties. 

Keeping in mind this basic and vital difference be- 
tween air that is, and air that is not, fresh, we may now 
proceed to the consideration of those attributes of fresh 
air that are less readily explained. 

Some Everyday Incidents Give the Clue. (1) At 
some time or other have you not remained in an indoor 
ill-ventilated room until finally the air became so warm, 
stagnant, and " muggy" that you felt stifled and ap- 
parently almost suffocated? Then, on seeking relief by 
stepping outside, as the sharp draft of cooler air struck 
you in the face, have you not immediately felt refreshed 
and invigorated? Of course you have noted this; but 
have you ever stopt to think that the relief was 
instantaneous? — that you were freshened and braced at 
once, before there was time for you to take one breath 
of the new atmosphere? 

(2) Likewise, on some warm day, after spending a 
half hour admiring the greenery in some glass-roofed 
conservatory, with its pent-up, warm and humid, motion- 
less monotonous air — at the end of the little journey 
through the passageways, on emerging once more into 
the unconfined, restless, cooler outside air, have you not 
had a similar feeling of immeasurable relief, as tho a 
heavy load had just been lifted from you? Moreover, 
has not this relief come the moment you have passed 



260 LESSONS ON TUBEECULOSIS 

through the portals of the conservatory — before you 
have had any opportunity to inhale the fresh, clear, 
deliriously stimulating outer air? 

(3) Again, is there anyone who has never known 
the keen stimulating feeling, and the pleasurable, health- 
ful glow that follows a cold bath ? Odd as it may seem 
at first thought, the benefit derived from living in the 
open and the benefit derived from a cold bath are 
brought about in much the same manner. 

It will be shown in a moment, that the commonplace 
experiences just described, taken together, furnish the 
master key to the merits of fresh air. First, however, 
it seems desirable to attempt to dissipate the clouds of 
misconception which so commonly hinder one from ob- 
taining an unbiased and open view of the matter. 

Some Newly Discovered Facts. Unfortunately, 
space will not permit the presentation of details ; it can 
only be stated that a great mass of evidence has accumu- 
lated to show that — 

1. Inside and outside air differ much less in their con- 
tents of oxygen and waste products* than has formerly 
been supposed. 

2. The body can utilize only a small part of the oxygen 
present in ordinary air. Even in an indoor room, unless 
the atmosphere be " close' ' and stale indeed, the amount 
of oxygen is more than sufficient for the respiratory 
needs of the healthy person, and for the sick also, save 
under exceptional circumstances. 

3. The gases and effete matter eliminated during out- 
breathing exert little ill effect upon one, unless these 



* Among 1 these waste products, carbon dioxid is thought by 
many persons to be especially injurious. Strange as it may 
seem, some newly discovered facts strongly suggest that an 
excess of carbon dioxid in the body to some extent protects 
against and retards the progress of tuberculosis. In this con- 
nection it is significant that a concentration of less than 5 pes 
cent (a concentration which not rarely occurs in the body) 
definitely inhibits the growth of tubercle bacilli. 



ELIXIR OF HEALTH, FRESH AIR 261 

substances saturate the air to a greater degree than oc- 
curs in the usual indoor room. Lest this last statement 
lead to misunderstanding, a word of explanation seems 
in order: Altho the waste gases eliminated from the 
body are less injurious than was formerly supposed, the 
fumes given off from certain articles of the household 
equipment — for example, the fumes produced as a re- 
sult of the burning of natural or illuminating gas, as 
well as the gases escaping from improperly ventilated 
stoves and the like — are decidedly harmful. 

Local versus General Effect and Physical Qualities 
versus Chemical Make-up. Here it may be well to 
pause a moment and ascertain just what it is you com- 
plain of when the air is uncomfortable. Do you say : "I 
am suffering for the lack of oxygen," or do you ex- 
claim: " There is too much poisonous matter in this air! 
— I cannot stand it ' ' ? No ; very probably you say neither 
of these things. What you are really much more likely 
to say is : "How cold and damp the air is ; and isn't the 
wind raw and piercing V 9 Or on the contrary, you re- 
veal your feeling in some such manner as this: "How 
warm and steamy it is to-day ; how close and oppressive ! 
There does not seem to be a breath of air stirring." 

Does it surprise you to find that in one direction or 
the other you have found fault with the physical prop- 
erties of the air — such as the precise amount of air move- 
ment, its temperature and its relative content of mois- 
ture; that you have not been half so concerned about the 
exact chemical make-up of the air as you had thought? 
An effort will now be made to show that in your com- 
plaints you have hit upon three of the chief factors upon 
which the effect of air, for good or bad, depends. For a 
careful consideration of the facts itemized above, and of 
other recent discoveries along the same line, leads to the 
conclusion that air which is not fresh works a two-fold 
injury, as follows : — 



262 LESSONS ON TUBEECULOSIS 

(1) It offers the individual every chance of taking 
more and more germs into the body. In this way, the 
air that is breathed in is a menace. This may be looked 
upon as a local effect. 

(2) It undermines the resistant forces of the whole 
body, rendering it incapable of putting up an adequate 
defense against germs and disease. This general effect 
is brought about not only by the air that is breathed in, 
but by the air that surrounds the body (probably chiefly 
through the latter medium). 

Viewing the matter from a different angle, it is seen 
that a large part of the benefit from fresh air, perhaps 
its principal benefit, is derived from its action on the 
surface of the body. Thus, it is owing to the fact that 
the skin is exposed to a continuous air bath (for even 
when one is drest, air permeates the clothing to a 
greater or less degree) — this air bath having a stimulat- 
ing effect similar to the cold water bath — that the oft- 
times wonderful results of the outdoor life should be in 
large part ascribed. Once the air reaches the surface 
of the body, through the nerve terminals in the skin, 
and otherwise, health promoting processes that reach 
the most distant parts of the anatomy are instituted. 

Moreover, in one way or another, air as a surrounding 
medium abstracts heat from the body to a larger or 
smaller extent. The removal of heat in turn sets the 
bodily machinery in motion to counteract the loss. In 
responding to this new demand each and every cell is 
spurred on to do more work,* and (provided that this 
increased demand does not exceed the ability of the 
cells to respond) this increased work will mean better 



* Work y in this sense, is not to be looked upon as contrary 
to the health item, rest, as described in Lesson IX. A distinc- 
tion is to be made between useful work (that is, cellular activity 
which strengthens the function of each organ and contributes to 
the general fighting efficiency) and needless work, such as un- 
necessary physical labor, which calls for an output of energy 
though accomplishing nothing from the health standpoint. 



ELIXIR OF HEALTH, FRESH AIR 263 

work, and a building up of the general vitality and re- 
sistance to disease. Furthermore, research has shown 
that the precise amount of heat removed from the body 
depends chiefly on (a) the temperature, (b) the move- 
ment, and (c) the amount of moisture in the air. In 
other words, it is to the physical qualities of fresh air, 
such as its temperature, movement, etc., rather than to 
its exact chemical make-up, that the good effect of fresh 
air must be largely assigned. Of course, it is essential 
for each of these three factors to be regulated in accor- 
dance with the reactive power of each individual, regard- 
ing which practical suggestions will presently be given. 

Summary of Effect of Fresh Air. In a word, it may 
be said that the influence of fresh air is more a general 
one on the whole body than on the lungs alone. Inside 
air predisposes to tuberculosis by so wearing down the 
general vitality that the individual falls a ready prey 
to most diseases, including, of course, tuberculosis. The 
danger is accentuated because of the comparatively large 
number of germs present in impure air. Outside air, 
which contains a smaller number of germs, is a general 
tonic to the whole body, augmenting its defensive forces, 
and bracing, hardening and building up the individual, 
so that he is enabled to withstand much exposure and 
to effectually ward off disease. Thus, he is to a large 
extent protected against tuberculosis; if already af- 
flicted, he is aided in ridding himself of the malady. 

The Importance of Fresh Air Emphasized. Altho 
the newer discoveries have shown that the benefits of 
fresh air are brought about in a somewhat different 
manner than old tradition and hasty speculation would 
have had us believe, fresh air is nevertheless highly 
essential to health. More, owing to the fact that fresh 
air is now known to give double value, through its whole- 
some effect both upon the lungs and upon the body as 



264 LESSONS ON TUBERCULOSIS 

a whole, it would seem to be even more necessary to 
recovery than it has heretofore been generally con- 
sidered. 

It is not unlikely that the above description of the 
action of fresh air at first appears a little confusing, 
even uncalled for. If for the present, however, the 
reader will content himself merely with making a mental 
memorandum of the matter, as he reads on in this les- 
son, under the discussion of drafts, fog, bodily warmth, 
clothing, heating systems, etc., he will find the facts 
concretely applied, and will probably be convinced that 
the space given to the discussion of the why and where- 
fore was not wasted. So, too, when discussing climate 
(see next lesson) the basic truths appearing herein will 
be again referred to. 

The Nose, an Inefficient Sentinel. Under ordinary 
circumstances, if a number of persons are congregated 
in an improperly ventilated room, conditions are right 
for producing just the effect that is not wanted. The 
air tends to stagnate, to become either too dry or too 
humid, and to become overheated; till sooner or later 
a "stuffy" feeling is noticed and an odor that is offen- 
sive develops. Because in many circles the belief is com- 
mon that the nose can safely be relied upon to tell when 
the air is "bad," it seems advisable to lay stress on the 
fact that this is a decided error. It is important for it 
to be understood that the nose detects only gross foul r 
ing of the air, such as that due to perspiration or to the 
accumulation of other organic impurities — factors which 
are not the primarily vital ones. This means that 
air is often quite unfit for use long before it is vetoed 
by the sense of smell. 



ELIXIR OF HEALTH, FRESH AIR 265' 
General Instructions for Living in the Open Air 

Residence in the Country an Advantage. Whether 
or not in a given case, it is prudent for one to make a 
change of climate or to seek rest and tranquillity in a 
sanatorium, some change of residence, at least to the 
country, is a great advantage in nearly all cases. The 
purity of the air increases in direct proportion to the 
distance from habitations and from cities. In the coun- 
try is also found an entirely different environment 
which, with its new and pleasant attractions, com- 
pletely separates the sick person from the temptations 
of work and friends, thereby often adding materially 
to his chances. 

Continuous Life in the Open Desirable. Barring 
unusual circumstances, one should spend as nearly as 
possible twenty-four hours out of each twenty-four in 
the open air. This does not imply that it is either neces- 
sary or wise for the invalid to rest directly under Na- 
ture 's sky; but it does mean that unless there be a 
potent contrary reason, he should at all times be supplied 
with an abundance of fresh, unadulterated air. The 
rule holds true whether the patient be in bed or up 
and around. Unless also suffering from hay fever 
or from certain forms of genuine asthma related to hay 
fever, it may be said that it is impossible for one to 
obtain too much air, fresh from the outside. 

Unwarranted Pear of Fresh Air. How many there 
are who allow an excessive fear of drafts to interfere 
with the effective carrying out of the open-air treat- 
ment. Strong drafts are, of course, not desirable, but 
their influence for harm is less marked than many sup- 
pose. If it be recalled that moderate movement of the 
air (that is to say, a slight draft) is one of the highly 
prized virtues of open air, dread of drafts will be less 



266 LESSONS ON TUBERCULOSIS 

common. Night air is the bane of others; yet there is 
absolutely no real ground for the belief that night air 
is injurious. As a matter of fact, in cities, owing to the 
comparative absence of dust and smoke, the night air is 
the purest and best air. Still others hold that great 
harm will come from the breathing of damp air during 
foggy or rainy weather. This apprehension is also un- 
warranted. Just as extremely dry air is not the best 
air, so air that is highly saturated with moisture is not 
the best air. Yet even decidedly moist air is better 
than the stagnant, devitalizing atmosphere of a tightly 
closed room. Again, there are those who believe that 
they should remain indoors on cold days. This, too, is 
an error; for cold itself is an exceedingly valuable 
stimulant, and, as a matter of fact, many make most 
rapid progress during the cooler season. 

The Rule of Reason. Persons so inclined wish to 
shut out the air when any slight change in the weather 
occurs. This is quite a grave mistake. On the other 
hand it is just as serious a transgression for one to 
wantonly expose himself : It is to be distinctly under- 
stood that discretion must be used in administering 
the air baths. One should strive to obtain at all times 
the maximum amount of fresh air consistent with sane 
protection from strong drafts, violent winds, dust and 
extreme cold, and from the direct wetting of the body 
by a driving rain, etc. However, one who has become 
inured to the outdoor conditions is often remarkably 
resistant to the little ups and downs of the weather, and 
protection is then less important. 

Daytime Apathy. In direct contrast to the views 
and actions of those who (as just explained) through 
fear of injury fail to take full advantage of fresh air 
while they are sleeping, there is another group of per- 
sons who, painting with a highly colored brush the 



ELIXIR OF HEALTH, FRESH AIR 267 

merits of outdoor sleeping, with small respect for the 
wishes and rights of others are wont to insist with almost 
fanatical zeal that they have their full allotment of fresh 
air at night; then, just as fog melts before the rising 
sun, with the coming of the day their efforts evaporate, 
and they face about completely in their practices, 
serenely content to pass their waking hours in indoor 
rooms where the air is stale and stifling, with a most 
surprizing indifference to their daytime living condi- 
tions. 

What inconsistency ! What folly ! There is only one 
way to get from fresh air all that it offers. He who is 
putting his heart and soul into the fight will do his 
utmost to secure for himself fresh air all the time. It 
should always be remembered that fresh air means life. 

Precautions Suitable to Elderly and Very Sick Pa- 
tients. Elderly and delicate persons and those suf- 
fering from far advanced disease are apt to be espe- 
cially sensitive to exposure, so for these a more guarded 
and moderate adjustment of the factors of temperature, 
humidity and air movement is imperative.* 

Moreover, for such persons a definitely graduated 
change to the new conditions is the safer method, the 
more so if the outdoor life be taken up during stormy or 
wintry weather. A few days or a week or two, or in 
some cases even longer, may be profitably spent in 
accustoming the invalid by progressive steps to the new 
plan. Let it be emphasized, however, that those who 



• This means that measures for insuring protection from 
violent wind, bitter cold, immoderate dampness, etc., are more 
important for patients of this class. If the treatment is carried 
out in a cold climate, a few of these more delicate patients may 
never become inured to the same conditions that others will 
stand with ease; and for some, especially those who have to rise 
frequently at night, and for those who find that their catarrhal 
symptoms, such as may be due to bronchitis, are aggravated by 
slight air changes, a well ventilated room may be the best abode. 
Nevertheless, the aim should be to harden even these patients 
to the greatest degree possible. Most surprizing results in this 
direction are ofttimes obtainable if one is willing to try. 



268 LESSONS ON TUBERCULOSIS 

actually require special care are comparatively few, 
while those who think their cases are exceptional are 
numerous indeed. 

Then, too, one should also be on guard, lest the change 
be made so slowly that it is never completed. Those 
hesitating persons who, harboring the delusion that in 
so doing they are protecting themselves, postpone the 
day for making each little change from week to week 
and month to month, should realize that through this 
dilatory action they are actually paving the way for the 
development of colds ; against which the continuous life 
in the open is really their strongest safeguard. 

Also, in connection with colds, it should be remem- 
bered that sudden and pronounced changes of air condi- 
tions are often of more importance than the exact tem- 
perature of the air, the precise amount of moisture it 
contains, etc. For example, think of how many times 
on a cold, wintry day, one passes from the ill-ventilated, 
overheated indoor rooms to the fresh, cold, outside air, 
and the reverse; bearing in mind that each sudden 
transition of this nature catches the body unprepared 
and directly predisposes to the taking of cold. That 
these two evil influences may be obviated, it is important 
both that the least possible time be spent indoors (even 
at meal-time the stay should be cut to the minimum), 
and that the indoor rooms be thoroughly ventilated and 
maintained at proper temperature. 

Practical Hints on Ventilation. The topic, tem- 
perature, will be discussed a little later; here it may 
be well to say a word or two on the subject of ventila- 
tion. 

One of the simplest and most effective ways in which 
to secure adequate ventilation is by a cross current of 
air obtained through openings on opposite sides of the 
room. Even tho the patient is weak and the weather 



ELIXIR OF HEALTH, FRESH AIR 269 

cold, it will be helpful to secure a thorough change of 
air in this manner by opening wide the doors or windows 
at frequent intervals. A few moments will suffice to 
renew the air, and during this time an extra cover may- 
be placed on the patient or a screen placed in position 
to shield him from direct draft. 

When the windows are confined to one side of the 
room, one must perforce make the most of the situa- 
tion by securing the best possible ventilation under the 
circumstances. In this case, the lower sash should be 
raised a few inches, for the entrance of the heavier, 
cooler, pure air; whereas the upper sash is dropt a 
like distance, for the exit of the warmer and lighter, 
foul air. In order that the window shade may not im- 
pede the exit of air through the upper opening, the 
shade should either be attached to the sash or fastened 
lower down on the casing than is customary. 

Dr. Carrington, in his excellent and profusely illus- 
trated book on fresh air, written for home use,* has 
suggested that the shade be attached to the roller by 
several pieces of tape of convenient length, or by a piece 
of strong coarse mosquito netting ; pointing out that if 
the netting is the same color as the shade, the device 
is hardly noticeable. The shade should be shortened 
sufficiently so that when drawn down to its full length 
in order to expose the upper opening, a clear path will 
also be left for the entrance of air below it. 

During bitterly cold weather, a wooden strip, secured 
to the lower end of the window casing, is useful in 
shielding the occupants of the room from a direct draft, 
while leaving an entrance way for air between it and 
the lower sash. 

NOTE: It goes without saying that these are all 



* "Fresh Air and How to Use It," by Thomas Spees Carring- 
ton, M. D., published by the National Tuberculosis Association, 
370 Seventh Ave., New York. 



270 LESSONS ON TUBERCULOSIS 

merely cold-weather suggestions. In the warm season, of 
course, the aim should be to throw wide all doors and 
windows so far as can be done and at the same time 
keep the temperature within healthful bounds. During 
hot weather and in tropical countries, in order to keep 
the rooms reasonably cool, it may be necessary to close 
most of the openings while the sun is high, but as soon 
as feasible they should be opened wide. Latticed cur- 
tains of the Venetian-blind type and Japanese mat- 
ting curtains are very practicable for keeping out the 
intense sunlight, while permitting ingress and egress 
of air. 

On hot, sultry, still days an electric fan is a very 
helpful device, and will yield large returns, both in re- 
lief and actual benefit, for the amount invested, pro- 
vided care is used to avoid taking cold. The fan should 
not be too near the person, nor its speed excessive. 

The Sleeping Quarters 

If practicable, the sick person should occupy a sepa- 
rate room; at all events he should sleep in a separate 
bed, which should be at least four feet distant from 
that occupied by another person. A room with screened 
openings on three sides equipped with suitable curtains, 
one or more of which may be lowered when desired; 
with an alcove off the fourth side, which may be heated 
for dressing, is very convenient. If the choice is limited, 
a room with a maximum number of windows and a 
southern exposure should be selected as a rule. Those 
who from necessity must make use of a room with only 
one window, should sleep with the head of the bed near 
the window, which should ordinarily be wide open. If 
the patient be very weak or the weather decidedly cold, 
it may be desirable to use a window tent, which may be 
purchased at small cost, for obtaining ventilation with- 
out undue exposure. 



ELIXIR OP HEALTH, FRESH AIR 271 

The furnishings of the room should be simple and 
easily removed and cleaned. When not in use the sleep- 
ing quarters should be flooded with sunshine. When 
occupied the amount of sunlight admitted should be 
governed by the peculiar needs of each individual. 

In cold climates, a room with wide French windows 
opening on a balcony is an excellent arrangement. Bed 
patients may spend the day on the balcony, and if the 
weather is extremely disagreeable, the bed may be rolled 
indoors at night. The night quarters should also be 
thoroughly ventilated. 

The Method and Your Means. For those of limited 
circumstances, a lean-to or a shack may be erected upon 
the roof of the dwelling or apartment ; or, with a little 
thought one can devise appropriate means for providing 
shelter upon some porch or balcony. With merely these 
simple and meager appurtenances, many a person with 
slender means has won his way back to health. 

Tents and Tent Houses. In other cases, a tent or 
a tent house may be utilized. In order that drainage be 
thorough, the domicile should preferably be situated 
at a slight elevation. The ordinary tent does not 
afford sufficient ventilation and moreover, is abominably 
hot in the summer, and uncomfortably cold during the 
winter, 

A wall tent may be improved considerably by con- 
verting it into a tent house. For this purpose, a floor 
placed well above the ground, on which wooden walls 
two and a half or three feet high are constructed, to- 
gether form the ground- or frame-work upon which the 
tent is set. A canvas fly suspended a foot above the 
tent is of great advantage. The walls and ends should 
be capable of being rolled up or opened wide, to permit 
free circulation of the air. A large opening cut in the 
center of the roof of the tent proper, to allow easy exit 



272 LESSONS ON TUBERCULOSIS 

of the air, is a feature of great value. Flies and insects 
may be kept out fairly well by the liberal use of mosquito 
netting. A canvas roof extended out in front of the 
tent, under which, if permissible, one may sit or recline 
during the day, is an inexpensive but very useful addi- 
tion. 

How to Construct an Individual Bungalow at Rea- 
sonable Cost. An individual bungalow, like those in 
use in many sanatoria, which can be built at moderate 
outlay, makes a very satisfactory abode for some pa- 
tients. A bungalow of this type consists essentially of 
three parts : a small veranda in front ; a middle room for 
ordinary use, with side walls two and one-half or three 
feet high on three sides, above which are large screened 
openings, equipped with curtains that may be manipu- 
lated from within; and a smaller room in the rear for 
dressing, supplied with a clothes closet and, preferably, 
with a sanitary wash bowl and a toilet and bath. Addi- 
tional smaller screened openings of perhaps a foot in 
width, located just beneath the eaves, and other open- 
ings in a cupola in the roof (to provide for ingress and 
egress of the air in case very stormy weather makes 
necessary the lowering of all the curtains), are valuable 
additions. Such a bungalow may be erected for from 
two to five hundred dollars, depending upon the size, 
details and equipment. 

In building the bungalow, there are two or three 
apparently inconsequential points, but which if given 
attention will mean much for the comfort and peace of 
mind of the occupant. (1) Care should be taken to 
make sure that the curtains or devices of whatever na- 
ture provided for closing the screened openings, are so 
constructed as to prevent the rubbing, flapping or bang- 
ing of the canvas against the metal screens during windy 
weather. At night all noises are magnified; so at this 





COXTRASTIXG CURTAIN TYPES 

Above, a sleeping porch equipped with closing devices which may be 
swung outward. The advantages are that ventilation is provided for 
even while the rain and the sun (if undesired) are excluded. The lower 
photo shows the sliding type of curtain. A more simplified system of 
ropes and pulleys are used for curtains of this type, and they hold their 
alinement better and retain a pleasing appearance longer. 



ELIXIR OF HEALTH, FRESH AIR 273 

time, particularly, lack of foresight in this direction may- 
prove very annoying and distressful to sensitive per- 
sons. Perhaps the most practical and simplest way of 
avoiding the difficulty is to have the metal screens placed 
on the inside instead of the outside of the wooden 
framework ; taking the precaution, also, to leave a space 
of two inches between the wooden upright supports (in- 
serted for strength at one or more places in the length 
of the openings, and which divide the screening into 
several panels) and the canvas curtains, when tightly 
closed. Even if the canvas flaps are firmly fastened to 
wooden frames, the precaution is still necessary ; for no 
matter how tight the canvas is stretched, it will in all 
likelihood soon loosen and may become a source of 
much annoyance, if not separated from the screen by 
a sufficient distance. 

(2) If curtains capable of being swung outward are 
used, the ropes for manipulating the curtains should be 
fastened to the curtains or curtain frames in such a man- 
ner as to prevent the rain from running down the ropes, 
thence through the holes piercing the walls of the bun- 
galow, through which the ropes slide, and onto the floor. 

(3) It is an advantage to use some type of curtain 
that may be swung outward at an angle to admit the 
fresh air and yet keep out the sun and rain, but which, 
when desired, may also be opened in such a manner as 
to flood the interior with sunshine. 

(4) In hot climates, a double roof will serve to render 
the air inside the bungalow cooler and more comfortable. 

In Dr. Carrington's book on fresh air (previously 
mentioned), may be found many other helpful sugges- 
tions concerning outdoor living and sleeping quarters 
of many types, with plans and illustrations. 



18 



274 LESSONS ON TUBERCULOSIS 

Bodily Warmth and Eesistance to Disease 

Elsewhere in these lessons it has been explained that 
neither extreme heat nor extreme cold is suitable for 
the sufferer from tuberculosis. However, the general 
rule may be formulated that the more cold one can 
become accustomed to withstand without ill effect, the 
greater the benefit. There is no question that a great 
many persons love heat too well for the good of their 
health. 

How many there are whose living rooms are kept 
above brood-oven temperature, who at the first sign of 
fall or winter begin to hug the fire, and who at all seasons 
over-burden their bodies with heavy wearing apparel 
during the day, and are inclined to weight themselves 
down with multiplied layers of bed clothing at night! 
It is of course highly important that one take all neces- 
sary precautions for securing adequate protection 
against the elements; on the other hand it is not only 
useless but is definitely hurtful for one to live in a super- 
heated atmosphere or to swathe the body in too heavy 
covering. It is self-evident that the needs of no two in- 
dividuals are exactly the same; yet one should let sink 
into the memory the fact that each degree of heat added 
to the temperature of the living or sleeping quarters, 
each extra blanket that is used and each extra article 
of clothing that is worn, above the actual requirements, 
rob one of just that much resistance, delaying by a 
corresponding length of time the acquirement of that 
general toughness and hardening — that general rugged- 
ness and vigor — which is so much desired. 

Long habit has in many persons produced so deeply 
ingrained and so intemperate a longing for heat, that it 
is ofttimes necessary to discipline one's desire in this 
regard. With practise it is surprising how little warmth 



ELIXIR OF HEALTH, FRESH AIR 275 

one may accustom oneself to get along with, with in- 
creasing benefit. One should seek the least amount of 
heat that gives reasonable, but not luxurious, warmth 
and comfort. 

Temperatures Recommended. As to the actual 
temperatures recommendable, it is impossible to make 
a rigid rule. A room that seems just warm enough to 
one person may feel intolerably hot to another, and too 
cool for a third. For this reason, let it be understood 
that the following temperatures are given only as suit- 
able for the average patient, and that in the given case 
some modification up or down the scale may be called 
for. Under ordinary circumstances I would recom- 
mend 60° to 65° F. for the sitting room or study; 
even in exceptional cases it is seldom advisable for 
the temperature to be raised above 70° F. For the 
workroom, 60° F. or less, is usually sufficient. If it 
were possible to keep the mercury in the sleeping quar- 
ters as low as 60° F. at all times this would prove best 
for the great majority of persons. Needless to add, 
it is often an advantage to have the temperature of 
the sleeping apartment considerably below this point. 

In deciding on the exact temperature that is best, 
one must fall back on the ancient test of common judg- 
ment. Manifestly, one should never allow oneself to 
become so cold as to actually suffer harm ; at the same 
time, if one has been wont to pamper oneself in the use 
of heat, one cannot expect to continue to do so. 

Some Moisture in the Air Desirable. Before leav- 
ing the subject of temperature there is one point that 
deserves emphasis. Certain patients hold firmly to 
the conviction that no moisture in the air is desirable. 
These persons are not only mistaken, but if they attempt 
to put their belief into practise, are in danger of doing 
themselves direct harm. It is therefore necessary to lay 



276 LESSONS ON TUBERCULOSIS 

stress on the fact that neither air that is highly saturated 
with moisture, nor air that is extremely dry, is con- 
ducive to the highest state of health and happiness. 
What is wanted is neither the withering, intensely dry 
heat of the blast furnace, nor the wilting, steaming, op- 
pressive air of the hothouse. Here, as elsewhere, the 
happy medium should be sought. When the air is ex- 
ceedingly dry, drafts are felt more keenly, and one is 
inclined to chill more readily than if the air were rea- 
sonably moist. So, too, extremely dry air not only pro- 
duces feelings of fulness and discomfort in the nose and 
throat, but actually smooths the path for the develop- 
ment of colds, catarrh and tuberculosis. 

For the temperatures mentioned, the aim should be to 
have the humidity somewhere between 40 and 70 per cent, 
the exact percentage varying according to the require- 
ments of the individual case. Important: This de- 
gree of humidity is to be looked upon as correct only so 
long as the temperature remains within reasonable or 
moderate bounds. In other words, with either a very 
high or a very low temperature, even this much humidity 
is undesirable. 

Persons who have heretofore found that the room 
temperatures mentioned above produce chilling, would 
do well to investigate the relative amount of humidity 
present. Often this will be found as low as 30 per cent. 
If the requisite amount of moisture be added, to one's 
.surprize the same temperature will now be found quite 
comfortable and agreeable, as well as more healthful. 
The consideration of the means whereby the atmosphere 
may be properly moistened, naturally leads to the ques- 
tion of — 

Methods for Supplying Heat and Light. In all 
cold climates, some provision must be made for furnish- 
ing heat to the living quarters when necessary. For 



ELIXIR OP HEALTH, FRESH AIR 277 

this purpose, wood, coal, steam, hot-water or hot-air 
heating systems are all fairly satisfactory, or may be 
made so. 

Some of the ordinary heating devices have a pro- 
nounced tendency to exhaust the watery vapor from the 
air, thereby rendering it extraordinarily dry and un- 
healthful, as just explained. On the other hand, many 
of the more up-to-date heating systems are equipped 
with some form of air-moistening device. One should 
make sure that the moistening apparatus is in proper 
working order and that it is kept at all times supplied 
with water. If the heating system of the home lacks the 
air-moistening equipment, separate air-humidifiers for 
attaching to the radiators or elsewhere may be pur- 
chased. Or, the same need may be filled by simply plac- 
ing pans of water on the radiators or stoves for 
evaporation. 

As previously noted, gas stoves when not properly 
vented, and coal-oil stoves, saturate the air with poison- 
ous fumes, and are for this reason preferably banned. 
As sources of light, for a similar reason, electricity is 
safer than illuminating gas. There is no great objection 
to coal-oil lamps. 

How to Sleep Out of Doors with Comfort and 
Benefit 

The bed should be so situated in the room as to afford 
the sleeper shelter from violence of the elements. In 
keeping with this purpose, light canvas screens are in 
many cases very useful adjuncts. When the wind is 
strong, one or more of these screens may be put in 
place where most needed at the time, thus rendering 
efficient service in breaking the force of the wind with- 
out at the same time materially cutting off the supply 
of fresh air. 



278 LESSONS ON TUBERCULOSIS 

During the winter, a thick mattress, overlaid by sev- 
eral layers of heavy paper or a bed pad, or two mat- 
tresses with the paper pad between them, will effectively 
bar one important pathway of the cold. An arrange- 
ment of the pillows in the form of an inverted V will 
help to secure protection for the shoulders. If neces- 
sary, the bed may be warmed with hot-water bags, by 
jugs or bottles filled with hot water, by hot bricks, hot 
sand bags or stove lids, or by an electric heating pad 
or some similar contrivance. If the invalid recalls what 
has just been said as to the advantage of hardening 
himself as much as possible to cold, he will understand 
that these devices should be used as little as practicable. 
If the weather is bitterly cold, it is well for the patient 
to get into his bed (which has previously been warmed 
by hot-water bags or the like) while in a warm room 
and then be rolled outside. The method of tucking in 
all except the top-most cover under the bed pad, after 
which the top cover is folded under the mattress, affords 
perhaps the most satisfactory method of preventing the 
covers from sliding off. 

Sleeping bags, knitted hoods that cover all the head 
except the face, or other head covering (nothing should 
be used that covers the nostrils), nose protectors, made 
by fastening a piece of cotton across the bridge of the 
nose with adhesive plaster; and bed slippers — all are 
useful in securing protection from the piercing cold. 

A little care given to anointing the face with cold 
cream or a similar preparation, for the purpose of pre- 
venting chapping, does a great deal toward making 
sensitive patients feel at ease — thus promoting relaxa- 
tion and aiding rest. 

Outdoor sleepers who are troubled with the moonlight 
or the glare of the sun, may ofttimes find much com- 
fort and help by wearing a black band over the eyes. 



ELIXIR OF HEALTH, FRESH AIR 279 

Hints on Clothing 

All wearing apparel should be loose; tightly laced 
corsets should not be worn. For underwear, a light 
linen mesh fabric or other porous cloth that readily 
absorbs moisture from the skin and dries out quickly, 
should be selected for use during the summer months. 
Silk is also very satisfactory. Unless some extraordinary 
and valid contrary circumstance prevail, the wearing 
of heavy woolen underwear during hot weather is not 
only a hardship but is positively objectionable. For the 
outer clothing, some light colored, light weight goods 
such as Palm Beach Cloth, is comfortable at this time. 

As seasons follow one another, the change from light 
to heavy clothing and vice versa, should be made with 
caution. 

During fall and winter, linen, light or heavy cotton, 
wool or half -wool, are appropriate, according to the re- 
quirements and custom of each person. Two or more 
pairs of high woolen socks or stockings, may often be 
worn to advantage on very cold days ; if desired, a pair 
of cotton stockings may be worn next to the skin. Over- 
coats with high collars, caps that cover the head and 
ears, ear protectors, boots, leggins, gloves or mittens 
and wristlets — all have their virtues and should be 
worn as occasion demands. House slippers and bath 
robes should be placed near at hand at night, so that 
they may be donned immediately on slipping out of 
bed. 

If the feet are kept warm at all times, this contrib- 
utes greatly to the feeling of warmth and general well 
being. "When sitting up in cold weather, one or more 
steamer rugs or blankets should be placed on the chair 
and allowed to extend a short distance onto the floor, or 
even better, placed over a footstool or foot support of 
some kind. The patient then seats himself and the 



280 LESSONS ON TUBERCULOSIS 

blankets are carefully drawn around him and tucked in. 

A garment of unusual merit for out-of-door sitting is 
the so-called "Sitting Out Bag." Planned with the 
idea of giving effective protection from the cold with 
maximum comfort and convenience, the Sitting Out Bag 
has a lower portion made into a large roomy envelop 
for the lower limbs, while the upper part is designed 
to form a loose, comfortable covering for the body, 
shoulders and upper extremities. Free movement of 
the arms is provided for. Sitting Out Bags may be 
purchased in various sizes at a fair price from several 
firms, the Kenwood Bag, made of delightfully warm ma- 
terial, but which is not "weighty' ' or bunglesome, be- 
ing an especially good one. 

On rainy days, those who are abroad should see that 
the body is well guarded against wet and damp, by 
wearing some form of mackintosh or raincoat, by en- 
veloping the feet in snug rubbers or rubber boots, and 
by carrying an umbrella, if deemed advisable. The 
sou'wester is a simple yet very effective shield for the 
head and neck. If through oversight or accident the 
clothing or person should become wet, on no account 
should one fail at once to put on dry garments. 

Other helpful hints on outdoor living may be found 
in the pamphlet entitled, "Sleeping and Sitting in the 
Open Air," sent free on request by the National Tuber- 
culosis Association, 370 Seventh Avenue, New York, and 
in Dr. Carrington's excellent book already referred 
to on several occasions, obtainable from the same source. 

Why Indoor and Outdoor Crowds Should Be 
Avoided 

Apostles of the fresh-air life whose condition permits 
them to be up and around, quite naturally seek diver- 
sions of some sort to pass the time. The general ten- 



ELIXIR OF HEALTH, FRESH AIR 281 

dency is to seek amusement and companionship. Thus, 
one is often led to attend auto races, theaters, moving 
pictures, etc. It seems necessary to emphasize, there- 
fore, that these things, especially the indoor pastimes, 
threaten the success of the whole undertaking. In 
crowds are nearly always found one or more persons with 
fresh colds, tonsilitis, or the like; from whom may be 
acquired the very thing that it is highly important to 
keep clear of — that is to say, a " mixed infection." (For 
further light on mixed infection see Lesson IV.) Con- 
gregations of people out of doors, stir up dust, dirt and 
germs, which is bad enough. Indoors, the conditions 
are worse. In a crowded room, no matter how thorough 
the system of ventilation, the air can never be as fresh 
and pure as outdoor air. Moreover, those who mingle 
indiscriminately in indoor assemblages, have their pro- 
tective forces depleted at the very time that they are 
subjected to the chance of acquiring a large dose of 
fresh, and therefore probably highly virulent, germs. 
For this reason indoor crowds are to be shunned at all 
times. 

Is Sunlight Valuable and What Is Its Effect? 

In the rays of the sun, Nature has bestowed another 
blessing upon the sick. In no disease does the advent of 
a bright sunny day show so quickly on the patient as in 
tuberculosis. * 'Blues" give way to a more "rosy " view, 
and this brighter outlook in turn causes a change for 
the better in the disease. This cheering influence is one 
of the most important effects of sunlight, but the solar 
rays also have other beneficial qualities. Besides being 
a most trustworthy disinfectant of the air, sunlight is 
a valuable general tonic and blood builder, and is an 
able ally of fresh air in hardening the individual and 
in stimulating his defensive powers, thus indirectly 
" boosting' ' him toward success. 



282 LESSONS ON TUBEECULOSIS 

In order to obtain benefit from the sun, it is not 
always necessary nor even wise for the body to be ex- 
posed directly to its rays; altho in many cases direct 
exposure is a decided advantage. Heat from the sun 
is desirable only in limited amount; for it is the cold 
rays, including the ultra-violet, to which its beneficent 
effect is principally due. The rays penetrate the chest 
and reach the lung directly only in small amount, but 
are absorbed by the blood circulating in the skin, and 
carried to the innermost recesses of the body, including 
the lungs, where their influence for good is manifested 
by an invigoration of the body cells generally, by a 
stimulation of the healing processes of Nature, and, to 
a certain extent, by a destructive or germicidal action 
on the germs in the lungs. 

Rules for Taking the Sun Bath. At the outset, it is 
necessary to make clear that the same care and judg- 
ment must be used in determining whether or not one's 
case is suitable for the direct sun treatment, and in 
regulating the dosage of the sun's rays, that would be 
used in administering any powerful medicine. 

Oases Suitable. In general, the sun treatment is 
suitable for those patients who are able to be up, but 
if used with especial discretion, it may also be applied 
with benefit to many who are confined to bed. Ex- 
cept on the advice of the physician in charge, the treat- 
ment should not be taken by persons who have at any 
time had severe hemorrhages, nor by those who have 
recently shown even a trace of color. Moreover, it 
should not be taken when severe chest pains are present, 
when the pulse is above 100 while the patient is at rest, 
when the fever is above 99.5° F., nor when any evi- 
dences indicating that the disease is gaining rapid head- 
way are noted, nor when complications occur. 

Sun baths are as a rule not advisable for anyone who 
has ever suffered a sunstroke. 



ELIXIR OF HEALTH, FRESH AIR 283 

Method. The sun's rays are to be applied very 
gradually ; and a cool period in the weather or at least 
a comparatively cool part of the day should be selected 
for making the start. The top of the head should at all 
times be kept covered, and the eyes shaded by colored 
glasses if the light is very bright. The bath is taken 
with the patient reclining in the open, without the in- 
tervention of glass windows. 

A good method is to begin with a five-minute bath, 
with the feet only exposed to the direct rays of the sun 
while the rest of the body is kept covered or shaded. 
The effect should be carefully watched. If all goes 
well, the length of the succeeding baths may be increased 
five minutes daily ; also exposing each day a greater and 
greater surface area of the body. For example, the 
second day the feet are exposed ten minutes, and the 
legs from ankles to knees five minutes; the third day 
the feet are exposed fifteen minutes, the legs from ankles 
to knees ten minutes, and the thighs five minutes; the 
fourth day, five minutes is added to the time allowance 
for each of the previously exposed parts, and the 
abdomen is exposed five minutes; the fifth day again 
the time allowance for each of the previously exposed 
parts is increased five minutes, and the chest is exposed 
five minutes. From the sixth day onward, after taking 
the bath as just described for the fifth day, if the pa- 
tient 's condition permits, he turns on his abdomen and, 
beginning again with the feet, a similar course in apply- 
ing the treatment to the back is included in the daily 
program. Thenceforward, by a similar process, day by 
day the exposure of the whole body is gradually evened 
up. When this is accomplished, full exposure may be 
made each day from the beginning of the bath. 

Severe sunburn should be avoided, but to a greater 
or less degree a gradual tanning is both inevitable 
and desirable. 



284 LESSONS ON TUBERCULOSIS 

Safeguards. Weakness following the treatment ; note- 
worthy increase in the pulse rate that does not fall 
within one-half hour; a persistent slight increase in 
the temperature, or a great elevation for even a short 
time ; the development of chest pains ; a marked increase 
of the cough and expectoration traceable with reason- 
able certainty to the sun bath — any of these symptoms 
call for a more guarded application of the treatment, and 
in some cases for its abandonment. If even a tinge of 
blood appears in the sputum no further baths should 
be taken until the sputum has been clear for several 
days — and a longer interval should be allowed if the 
amount of blood has been larger. At all events, if 
any of these untoward symptoms arise the increase 
should be less rapid ; and it may even be necessary to 
make no increase, to shorten the seance, or to stop the 
treatment entirely, either temporarily or permanently. 
If the bath be omitted for one or more days, when re- 
sumed the duration or the area exposed, or both, should 
be correspondingly reduced. 

The Maximum Duration of the Bath. Altho longer 
periods are sometimes advantageous, unless the treat- 
ment be supervised by a competent physician it is as a 
rule unwise for those patients having even slight fever 
to prolong the bath beyond one hour, and for those with- 
out fever, beyond two hours. If things go smoothly, 
two baths daily, separated by an interval of a few hours, 
may be taken later. 

It should be emphasized that simple as this pro- 
gram may seem, faulty application of the solar rays 
may do much harm. Remember that the object is not 
primarily a bath of long duration. The aim should 
be to ascertain the length of bath that best meets 
one's own requirements and to lie in the sun for this 
period, and no longer. Haste has no part in the plan, 






ELIXIR OP HEALTH, FRESH AIR 285 

and it is in all cases advisable to do too little rather 
than too much. In climates where sunstroke is com- 
mon, all precautions should be redoubled. If the 

length of the bath be cut to suit the measure of each 
person, many will never reach the limit of exposure 
set down above. 

It should never be forgotten that the sun is a two- 
edged sword capable of doing good or harm, accord- 
ing to the way in which it is applied. When in doubt, 
do not take the treatment. 

If these rules be adhered to, one will usually be more 
than pleased with the results. In many instances there 
takes place such a remarkable building-up of the re- 
sisting power, that one is able to stand complete exposure 
(except the head) on very cold and even wintry days. 

Other Suggestions and Remarks. Applied in this 
manner, the sun treatment can satisfactorily be taken 
at home, if occasion requires. Suitable canvas strips 
or screens for securing protection from the wind and 
the curious, can be provided at small cost, making it 
easy for one to make effective use of the method, either 
on the roof or a balcony, or in the back yard. In the 
event that complete exposure of the person is unde- 
sirable or inconvenient, if the chest alone is exposed, 
this is often of considerable benefit. Caution: If the 
exposure of the chest is not preceded by exposure of 
the lower parts of the body, even greater care should 
be used, and it will be safest not to exceed two and a 
half minutes in the daily increase of the time allowance. 

Two useful outgrowths of the sun treatment are the 
artificial light treatment (discussed in Lesson XV) 
and an ingenious device, called the Solar Laryngoscope, 
for reflecting condensed sunlight into the throat, which 
has proven of marked benefit in tuberculosis of the 
larnyx or voice-box. 



LESSON XII 
THE TRUTH ABOUT CLIMATE 

The Fetish of Climate Worship. That climate is an 
important agency in the fight against tuberculosis, is 
undoubted. Yet it is equally true that each year thou- 
sands lose their lives solely because of an almost super- 
stitious faith in climate as a sort of magic talis- 
man. This supreme faith is unwarranted. It is very 
unfortunate that many who on no account should be 
moved, some in very weakened condition indeed, are 
still being sent on long journeys to lands where climate 
supposedly holds mysterious and miraculous sway over 
tuberculosis. 

Having reached their destination, how many there 
are who fall a prey to lonesomeness and homesickness, 
who suffer from the lack of proper food and other priva- 
tions and exposure; or who follow the alternative of 
taking up work when wholly unfitted to do so — in the 
end to perish in misery and wretchedness from one or 
more of these causes ! 

Climatic Pessimism. Directly contrasted with the 
extravagant laudation of climate, stands the opinion 
of another group of individuals who have become 
climatic pessimists. Basing their reasoning on cases 
wherein climate has failed to achieve all that has been 
expected of it, these persons are convinced that climate 
is practically worthless as an aid to recovery. 

Climate and Common Sense 

After listening to the arguments pro and con in re- 
gard to climate advanced by his friends, the sufferer is 

286 



THE TRUTH ABOUT CLIMATE 287 

often bewildered, and wholly at loss as to what to believe. 
In searching for the solution of the problem does it not 
seem logical to submit the case to the tribunal of com- 
mon knowledge and experience? In the first place, 
everyone is aware of the remarkable differences in the 
physical prowess and temperamental attributes of the 
various races inhabiting the globe. Who, for example, 
is not familiar with the sharp contrast between the 
energy and activity displayed by the people who inhabit 
temperate zones and the lethargic tendencies of those 
living in tropical climates ! — distinctive differences which 
it is quite generally agreed are due at least partly to the 
influence of climate. 

Second, getting down to your own experiences : Have 
you not, perhaps, at some time during life on taking 
up your residence in a new climate, noticed that you 
were pleasantly stimulated; or, on the contrary, found 
that you were weakened and depressed? Now, if it is 
borne in mind that these effects of climate, for good or 
bad, are noticed by those who are entirely well, is it 
not reasonable to suppose that climate will have a 
similar influence on the sick, modifying in one direc- 
tion or the other their ability to resist disease? 

The offhand answer is Yes ; and as a matter of fact, 
careful study of innumerable cases of tuberculosis by 
expert physicians in all parts of the world, has estab- 
lished the correctness of this answer, proving beyond a 
doubt that climate has definite value against tubercu- 
losis. 

Proof for Skeptics. Those who have little or no 
faith in climate, may perhaps convince themselves by 
examining with unprejudiced minds the stories of others 
who, after making a fair test of all other means for re- 
claiming health, without benefit, through making a 
change of climate have finally won the coveted prize. 



288 LESSONS ON TUBERCULOSIS 

True, in a large number of such instances, other factors 
inevitably associated with the move to the new climate 
must be given credit for boosting the patient along the 
route to health. Thus, the mere change of residence, 
as from the city to the country, or from the harmful 
influences that held sway in the old environment to the 
more peaceful and restful surroundings elsewhere; or 
again, the difference between a confining occupation 
indoors and the free life in the open — singly or com- 
bined — these influences have sufficed to renew the grip 
of the sufferer on life and happiness. In other in- 
stances, the inspiration of high hope or strong faith 
has served to cause a favorable turn in the tide. In yet 
another group of cases, time has been the determining 
element ; the disease running its course of ups and downs 
until the fire finally burned itself out and convalescence 
ensued. There is no doubt, then, that many who 
attributed their regeneration wholly or principally to 
climate, would have recovered just as assuredly, altho 
perhaps not so rapidly, in any climate. In these cases 
it was the new surroundings, or changed conditions of 
some sort, that were really responsible for the turn of 
fortune. 

What of Those Who Have "Come Back" After Ex- 
hausting Other Measures? None the less, if a pains- 
taking examination is made into the details of each case 
in which climate has been given the credit for recovery, 
after all the chaff is sifted out there remains a certain 
number of instances in which, one by one, other in- 
fluences may be cast aside, until only the factors of 
time and climate remain. Cases have occurred in which 
the patient had previously broken away from the ties 
of home and the hindering influences of the large city, 
and had moved to a suitable place in the country — 
without, however, changing climates. Here he had 



THE TRUTH ABOUT CLIMATE 289 

faithfully — only to continue going 
steadily downward. As a last resort, his funds nearly 
exhausted, with only a railway ticket and a few dollars 
in his pocket, he was lifted aboard a train and started 
upon a journey for better or for worse. Later, lone- 
some and heartsick, without faith in climate, hopeless, 
yearning to experience the relief of death, he was assisted 
from the train at some isolated spot. Now chiefly de- 
pendent upon his own efforts, he was perhaps even forced 
to spur his feeble body to put forth its fast flickering 
strength to obtain the bare necessities of life. 

Time passed. The invalid was surprized to find him- 
self still alive, to learn that he was even taking a new 
interest in things, and that his body was day by day 
growing stronger. A little later, he was overjoyed to 
discover that the improvement was continuing — until at 
last, despite the violation of all rules and regulations 
and the suffering of many privations, hardships and 
exposure, there slowly crept into his mind the realization 
that he had won ! 

Some skeptical persons may assert that even in such 
cases time was the determining factor, and claim that 
had the individual continued to "take the cure" in 
the original climate, the disease would have run its 
course and recovery have ensued just as certainly. Cases 
have occurred, however, in which the inroads of the dis- 
ease were so extensive and its progress so rapid, that it 
seems unreasonable to attribute the turn of the tide to 
anything else than climate. Altho not common, yet in 
the aggregate a considerable number of such cases have 
occurred.* 



* Such incidents furnish striking* proof of the beneficent 
effect of climate, but it should be distinctly understood, never- 
theless, that it is a serious mistake to change climates when 
this entails a sacrifice in more important health items. For 
example, ninety-nine times out of a hundred the course followed 
in the case just cited would have the very opposite effect and 
only hasten the unfavorable outcome. 
19 



290 LESSONS ON TUBERCULOSIS 

Climate Valuable but Not a Magician's Wand. 

Trials of climates of all varieties in innumerable cases, 
have proven conclusively that while climate is not by 
any means a sure cure, it is a remedy of considerable 
value. Alone, climate will accomplish little ; yet in con- 
junction with other health measures, if administered 
with discernment in appropriate cases, it is equally cer- 
tain that the proper climatic medicine will often in* 
crease the chances of success sufficiently to turn the 
scale from defeat to victory. 

Who Should Seek a Change of Climate? 

As the outcome of even the mildest case is not certain 
in advance, every patient will do well to take advantage 
of the benefit that climate offers, unless there be some bar 
to its use in> his own case. Before definitely deciding 
whether or not he will seek benefit from climate, it is 
important, therefore, to ascertain whether, all things 
considered, the change will prove profitable. 

QUESTIONS FOR CAREFUL THOUGHT 

1. Is the Sick Person Strong Enough to Stand the 
Strain of the Trip ; or, Is There Any Other Factor That 
Would Unduly Increase the Risk of Moving? First 
of all, let it be clearly understood that it is ordinarily 
both foolish and cruel to send away a patient who is 
in a very late stage of the disease and so manifestly ill 
that there is serious doubt as to whether he will survive 
the journey ; who, if fortunate enough to reach his new 
place of residence without mishap, will perhaps spend 
his last days in want and privation, far from friends 
and home. As a general rule, then, it is inadvisable 
for one who is extremely weak, who has a very high 
fever, or shows in other ways that he is exceedingly 
sick, to travel any great distance. 



THE TRUTH ABOUT CLIMATE 291 

The chances of a hemorrhage occurring should be also 
carefully appraised — not forgetting that the danger is 
increased if a hemorrhage has taken place only a short 
time previously, or if even a trace of color has been 
raised very recently. 

True, some whose condition seemed absolutely hope- 
less and who at the outset were in extreme exhaustion, 
have withstood a long, wearisome journey surprizingly 
well, and have obtained benefit from the change — ulti- 
mately winning complete victory. For this reason, no 
hard and fast rule can be made. Other factors, such 
as the length of the journey, the mode of conveyance, 
the ease with which the sick person can accommodate 
himself to the conditions of travel (that is, his ability 
to relax and rest while on the way), and the extent to 
which steps for promoting his comfort can be applied — 
these and other influences should be given careful con- 
sideration, letting the final decision rest on the sum- 
total of the merits of each case. 

2. Has the Health Seeker Sufficient Means, Both 
to Pay for the Trip and to Support Himself Properly 
While Recovering? Bear in mind that he whose 
pocketbook would allow only a brief visit at a health 
resort, in all probability will make the most of his op- 
portunities by remaining in his home climate, where 
his limited means will maintain him for a longer period. 
In this connection, it should be explained, also, that 
even in the mildest case it is unlikely that the invalid 
will be in condition to take up even easy work before 
months have elapsed. Moreover, it is often more 
difficult to find suitable light work in a health resort 
than elsewhere. Those who must pare their expenses 
closely should not forget that climate can be spared 
much more readily than other items of the treatment. 
Above all, avoid skimping on the elements of rest, 
food and time. 



292 LESSONS ON TUBERCULOSIS 

3. What Will Be the Influence of the Patient's 
Temperament on the Outcome? For example, if the 
invalid is to make the journey alone: Will the separa- 
tion from family and friends overbalance the good 
effect of the new climate? Kemembering that an en- 
vironment congenial to the individual temperament is 
highly important, if not indispensable to success; and 
that homesickness alone has upset the plans of many 
a patient — the probable extent of the effect of home- 
sickness in the given case should be estimated. Or, will 
the contrary influence prevail: will the freedom from 
the cares of the home, the severance of the old ties, and 
the complete removal from detrimental surroundings, 
be of immense benefit f 

A Word of Explanation. Those who endeavor to 
carry out the program for recovery at home or in some 
ordinary locality, very commonly find that their friends, 
neighbors and even their dearest friends and relatives — 
probably well and hearty themselves — do not under- 
stand that tuberculosis is serious enough to demand 
faithful observance of the rest schedule and other health 
items. If the disease has been recognized while yet 
early (when it is probable that the patient appears 
almost, if not entirely, well) it is even harder for those 
who have not studied the matter to appreciate that care 
and treatment is required. Often the neighbors and 
friends fail entirely to sympathize with the sufferer in 
his efforts to reclaim his health, failing also to give him 
that encouragement and moral backing which means se 
much to the success of the undertaking. In such cases, 
the successful carrying out of the plan ofttimes be- 
comes a very trying and difficult matter. For many, 
the remedy for this unfortunate state of affairs is the 
transferring of the residence to some place entirely away 
from old friends and relatives. 



THE TRUTH ABOUT CLIMATE 293 

For a considerable number of patients, one of the 
numerous well conducted sanatoria will, no doubt, pro- 
vide the right environment. (A general discussion of 
the advantages and disadvantages of sanatoria may be 
found in Lesson VII.) For others, however, such 
institutions are either unsuitable or, literally or figura- 
tively, out of reach. When this is true, the fact that it 
is easy to do the right thing in a community where 
others are doing likewise, and where on the whole one's 
new friends are better informed regarding tuberculosis, 
constitutes a strong reason for seeking a change of 
climate. (This statement holds good only in regard to 
the more famous places where patients congregate in 
relatively large numbers.) 

Caution. Altho, on the average, the residents of 
health resorts are fairly well informed on tuberculosis, 
the invalid is cautioned against intrusting himself to 
the guidance of his newly made acquaintances. In the 
new community he will find many who think themselves 
capable of giving advice on every phase of tuberculosis, 
but who, in fact, are only half informed, or even grossly 
ignorant, on the subject. Good advice will be mixed 
with bad, but as it will be difficult or impossible to de- 
termine when the one ceases and the other begins, by far 
the best plan is to secure a physician skilled in treat- 
ing tuberculosis, and abide by his counsel. If this is 
impracticable, after reading carefully the preceding les- 
sons, let each individual formulate a definite schedule 
suitable for his own needs, and thenceforward live up to 
it, regardless of what others may do or say. Remember 
that no two cases are exactly alike, and for this reason 
be on guard against taking up some unusual plan merely 
because it has proved successful in another case. 

A Related Question. Here may come to mind the 
thought: " If I go to some new locality and there re- 



294 LESSONS ON TUBERCULOSIS 

cover my health, will I be able to content myself and 
arrange my affairs so that I will be able, if necessary, 
to settle down in the new spot for the remainder of my 
days?" 

In answering this question, the following points should 
be borne in mind: — 

1. In all likelihood it will be unnecessary to remain 
permanently in the new climate. However, it will prob- 
ably prove advantageous to reside thereafter in some 
place having similar climatic characteristics. 

2. The relapses that not infrequently follow the 
return to the old home, as a rule are not due entirely, 
or even mainly, to the change back to the original 
climate. They are usually due — chiefly, at least — to a 
reversion to the old and faulty habits of living. 

3. With one exception, the chance that a fresh break- 
down will result from the return to the original climate 
is less than the risk of failure, should one elect to re- 
main in the old climate while • ' taking the cure. * 9 Stated 
differently, one is more likely to fail to find health in 
the old climate than one is to lose it there, after hav- 
ing won it elsewhere. 

The exception referred to is this : When a pronounced 
change of altitude is involved in the transfer of resi- 
dence, the problem is slightly tho not much more com- 
plicated. Suggestions for solving it will be given on a 
later page when considering the effect of altitude. 

If Already in a Healthful Climate, Is a Change 
Advisable? It is sometimes said that a climate other 
than that in which the health has failed should be sought 
regardless of the fact that one may already be living in 
a healthful climate. As a matter of fact, however, the 
breakdown has occurred chiefly because of improper 
living or working conditions; not because the climate 
has been unsuitable. For this reason, if the campaign 



THE TRUTH ABOUT CLIMATE 295 

for health is to be successful, a congenial and favorable 
environment is one of the all-essential requirements. If 
the proper environment cannot be obtained at home, it 
may be secured merely by leaving the city (or if already 
in the country, by moving to some new, tho not distant, 
locality), at the same time retaining the good that may 
be had from the climate. 

In a word, if already living in any one of the better 
types of climate, unless there be reason for suspecting 
that this particular type of climate does not agree with 
one, the "cure" may well be taken in the home climate, 
provided all other conditions are right. If then, after a 
reasonable period of trial has elapsed, satisfactory prog- 
ress is not noted, the change to a "good" climate of 
a different variety may prove beneficial. 

The Effect of Climate 

If full value is to be obtained from climate, it is im- 
portant that one have some understanding both of the 
effect of climate in general, and of the relative ad- 
vantages and disadvantages of each variety of climate. 

Some Old Beliefs Exploded. Odd as it may seem, 
investigations made in late years have disclosed the fact 
that climate is worth little as a direct antidote to pul- 
monary troubles. Contrary to a one-time prevalent 
opinion, no climate has been found that has a direct 
destructive or germicidal effect upon the germs of tu- 
berculosis, so long as they obtain refuge in the body. 
So, too, that climate is yet to be discovered which stimu- 
lates healing to any noteworthy degree through the 
direct action of the air upon the tuberculous lungs. 

Climate a Builder of General Resistance. In what 
way then is the good effect of climate brought about? 
Briefly stated, the influence of climate is exerted more 
upon the individual than upon the disease; more upon 



296 LESSONS ON TUBERCULOSIS 

the body as a whole than upon the lungs. In the main, 
climate has the same influence upon those suffering from 
tuberculosis as upon well persons, but the effect upon 
the sick is likely to be more pronounced. If the type 
of climate is suited to the particular patient, the multi- 
tudinous cells of the body are day by day strengthened 
and invigorated and each organ thereby rendered more 
competent to fulfil its appointed task. Outwardly, this 
effect is shown by the progressive building up and 
hardening of the sick person. Coincidentally, the natural 
defensive forces of the body are strengthened more and 
more — all making for a larger and larger development 
of the resistance to, and the power to overcome, ills of 
many kinds, among which is tuberculosis. 

Is Climate a Specific? As has just been shown, the 
chief effect of climate is not specific for tuberculosis; 
yet some evidence has been brought forth indicating 
that a certain element of climate increases — at least 
slightly — the resisting power against tuberculosis, more 
than against other diseases. Recent investigations have 
disclosed that in the bodies of persons residing at a 
high elevation there takes place a curious and inter- 
esting phenomenon which may have a direct bearing 
upon recovery. In such instances, an examination of 
the blood shows not only a general enrichment with 
red corpuscles, but reveals a special increase in that 
variety of white corpuscle known as the lymphocyte or 
lymph cell. Whether or not this increase in the num- 
ber of lymphocytes is merely a compensatory change — 
a change that serves only to balance or offset some in- 
jurious effect of altitude — is unknown ; but the fact that 
prior to this discovery many investigators had already 
reached the conclusion that the lymph cell plays an im- 
portant role in the body's battle against tuberculosis, 
gives weight to the view that altitude has, to a limited 
extent, a specific influence against this malady. 




AN ATTRACTIVE COMBINATION 

The combination of sliding canvas screens and awnings shown here 
gives the advantages of both the sliding and swinging type of curtains. 




A DOUBLE ROOF OVER THE SLEEPING PORCH 



adds greatly to the comfort and wellbeing of the sick person in hot 
climates. 



THE TRUTH ABOUT CLIMATE 297 

Caution: Remember, however, that the beneficial 
effect of altitude is in no case sufficient to warrant one 
in entirely disregarding its drawbacks (to be mentioned 
later). Only through a careful consideration of each 
feature of the particular climate under consideration, 
followed by a decision based upon the climatic picture as 
a whole, will the full reward from climatic change be 
reaped. 

The Local Effect of Climate 

It is quite common to hear some one say of air that 
contains very little moisture, that such air ' ■ dries up the 
disease in the lungs/ ' While this statement is not 
literally correct, yet if interpreted merely as meaning 
that through its local effect, dry air favors healing, it 
expresses the gist of the matter fairly well. 

Dry Air Lessens the Risk of Complicating Infections. 
Dry air as a rule contains relatively few germs. If this 
fact be coupled with the well-known observation that 
germs grow best in the presence of moisture, there is 
seen to be good ground for the presumption that the 
inhaling of drier air would not only render the lung soil 
relatively unfit for the seeds of tuberculosis, but would 
reduce the chance of adding more seeds to those already 
in the lungs. Similarly, the chance of acquiring 
"colds," or of having a secondary infection (infection 
with germs other than the tubercle bacilli — see "Mixed 
Infection," Lesson IV) engrafted on the lungs, would 
be minimized. What is more important: This theory 
has been upheld and confirmed by the multiplied teach- 
ings of experience; for the observation that "colds" 
and other infections are less frequent where the air is 
comparatively dry, has become commonplace. 

It is also well recognized that dry air has a tendency 
to reduce the quantity of the sputum. True, the de- 



298 LESSONS ON TUBERCULOSIS 

crease brought about in this manner does not signify 
that the destructive process in the lungs has abated 
correspondingly ; for it is mainly the watery constituent 
of the expectoration that is reduced. Less moisture be- 
ing inspired in the air, it is natural for less water to 
be eliminated in the sputum. Likewise, when the air 
is dry, so much water passes from the body in the form 
of sweat (visible or invisible) that very little water re- 
mains to be disposed of in the sputum. None the less, 
the effect is valuable, and, after all, the mere fact that 
the sputum is reduced in amount makes it probable that 
less effort will be required to raise it. Thus, the cough 
is cut down, the lungs are kept comparatively quiet, 
and Nature's delicate fibrils of healing tissue protected. 

Note: The effect of dry air is less important in the 
11 closed' ' case — that is, before softening of the tubercles 
has occurred and the resulting semi-liquid material has 
been discharged into the bronchial passages (discussed 
more extensively in Lesson IV). Yet even in this type 
of case, through its influence on the body as a whole dry 
air may be of considerable benefit. This effect will be 
more fully explained in a moment. 

Drawbacks of Dry Air. Mistakenly assuming that 
dry air has good qualities only, some pursue the search 
for a drier and drier atmosphere, regardless of its pos- 
sible ill effects. Sometimes, too, this quest for an ultra- 
dry atmosphere is carried out at the expense of highly 
important items in the health regimen. Do not forget, 
then, that dry air has bad as well as good points. 

Among its disadvantages, dry air is not rarely accom- 
panied by a peculiar electrical atmospheric influence. 
This has a tendency to make some patients quite nervous 
and restless and to cause sleeplessness — all of which in- 
terferes to a greater or less degree with the rest program. 
Again, extremely dry air has a tendency to cause a stuffi- 



THE TRUTH ABOUT CLIMATE 299 

ness in the head, and an annoying, uncomfortable feeling 
in the throat — both of which are disagreeable, to say 
the least. For patients suffering from tuberculosis of 
the larynx, to whose sensitive throats dry air is apt 
to be especially irritating, a change to a moister atmos- 
phere is sometimes helpful. 

The Moist-Air Bugaboo. It is to be regretted that 
there are many who take so exaggerated a view of the 
dangers of moisture that whenever a cloudy or rainy 
day occurs they live in a state of continual dread until 
the sky clears again. Such persons are prone to brood 
over the matter and to bemoan their fate, perhaps say- 
ing that if the fog or clouds do not soon melt away, they 
will lose their chances altogether. They may even work 
themselves into so excited a state as to anticipate ill 
effects from the weather ; and are continually hawking 
and spitting — perhaps forcing themselves to cough. If 
the truth were known, the increase in their symptoms 
on such occasions is half imaginary; the forced efforts 
to clear out the breathing passages serving only to pro- 
voke irritation and to "start something." If the in- 
valid will only make up his mind that perfect conditions 
are unobtainable, and resign himself to accept cheer- 
fully and gracefully the normal ups and downs of the 
weather, he will very likely find that the terrible ogre 
of moisture is largely a fabric of his own fancy. 

First and last, if he who wishes to make the most of 
his opportunities will impress upon himself the fact 
that recoveries take place in all climates, and that dry 
air, too, has its limitations, he will be less likely to fall 
into the common error of making his slogan "A dry 
climate, the drier the better," when perhaps a rela- 
tively moist atmosphere would be better for him. 

(In the preceding lesson, both sides of the moist air 
question are presented from a different angle, so if the 



300 LESSONS ON TUBERCULOSIS 

effects of moisture and dry air are not entirely clear, 
it may be helpful to refer to the previous lesson now.) 

The Attributes of a Healthful Climate 

Years ago, oxygen and ozone (the latter especially) 
were credited with marvelous powers over tuberculosis, 
the percentage of oxygen or ozone in the air being quite 
generally accepted as a reliable index to the value of 
a particular climate. Now, it is known that the influence 
of climate for good or bad turns almost entirely upon dif- 
ferent factors. Moreover, it has been definitely estab- 
lished that in climates wherein a superabundance of 
ozone or oxygen was assumed to be present, frequently 
the air contains no more than an ordinary amount of 
these gases. 

Primary and Secondary Characteristics of Climate. 
According to the modern understanding, the essential 
or primary requirements of a "good" climate are: (1) 
Purity of the air (that is, its relative freedom from 
dust and germs). (2) Moderate movement of the air 
(without, however, violent wind). (3) Abundant sun- 
shine. All climates useful in tuberculosis have these at- 
tributes. In addition, in most cases, a rather wide varia- 
tion between the night and day temperatures — say 
around 20 degrees — is desirable. For some, however, 
such diurnal changes are unsuitable (see below). At all 
events, it is important that the climate be on the whole 
fairly equable (that extreme weather changes be absent 
or infrequent) and that the factors of air temperature 
and moisture be kept within reasonable bounds. 

The principal secondary characteristics of a favorable 
climate (that is to say, the characteristics upon which 
its exact type depends) are: (a) The elevation above 
sea level, (b) The temperature of the air. (c) The 
humidity (within the limits just mentioned). Aside 



THE TEUTH ABOUT CLIMATE 301 

from these factors, the amount of electricity in the air 
has some influence upon the effect of the climate. 

Stimulating versus Eelaxing Climates 

All climates may be classified broadly under two 
heads: (1) Stimulating or bracing climates. (2) Sooth- 
ing or relaxing climates. Between these contrasting 
types, minor divisions, in which are included the mildly 
invigorating, and the moderately relaxing, climates, may 
be made. 

A climate that is strongly stimulating acts like a pow- 
erful tonic to the entire body, giving strength and vigor 
to each of its organs. If the patient is to obtain benefit 
from this type of climate it is paramount that he be able 
to respond to the increased demand on his resources. 
If he is unable to meet this demand, harm rather than 
good will result. A climate of this variety calls upon 
each cell of the body for greater activity. If the case 
is suitable, the energy spent in this manner is not wasted, 
but is utilized in raising the resistance of the body 
against disease, to the maximum. 

On the other hand, in other cases (cases unsuited to 
a stimulating climate) a relaxing climate brings about 
a similar end — in a different manner. Through the 
smaller demand that this type of climate makes upon 
the body, the output of energy is cut to the minimum. 
In this way the various cells of the body are given a 
comparative rest and afforded an opportunity to regain 
their customary strength, which is then utilized in con- 
centration against the tuberculosis. 

Other things being equal, cold, dry air is stimulating ; 
a warm, moist atmosphere, relaxing. For the invalid 
who requires stimulation, the effect of a relaxing climate 
may be so decided as to produce weakness. For the 
patient whose reserve of energy is low (who needs a 



302 LESSONS ON TUBERCULOSIS 

relaxing climate), the greater demands imposed by a 
stimulating climate may so exhaust the energy that in 
this case, too, weakness results. Again, if the stimulat- 
ing effect be very pronounced, the patient may be over- 
stimulated and kept continually nervous and "on edge." 

At high altitudes, a new factor, the lessened atmos- 
pheric pressure, contributes to the invigorating or stimu- 
lating effect. Then, too, the higher the elevation, the 
cooler and drier the air, as a rule. So at high alti- 
tudes the various influences combine to produce a very 
strong feeling of stimulation. On the contrary, at sea- 
coast resorts, where the air is commonly surcharged 
with humidity and the pressure high, the general effect 
is one of relaxation, which is more marked, the higher 
the temperature. 

On Pitting the Climate to Your Case. It is per- 
fectly true that for most of us any other climate is 
preferable to the sweltering, almost unbearable heat 
of the tropics, or to the bitter, frigid cold of the arctic 
zones. So, too, almost any type of "good" climate 
furnishes more healthful conditions than do the cold, 
changeable, blustery winters, and the hot and sultry, 
enervating summers, of many of our eastern and middle- 
western states. Yet if the invalid is anxious to secure 
the maximum profit from his sojourn for health, he 
should choose the climate most nearly fitted to his own 
needs. If circumstances prevent the decision being left 
to an understanding physician, by bearing in mind the 
classification of climates as (1) stimulating and (2) re- 
laxing — and by taking into account other factors to 
which attention will soon be called, the health seeker will 
be enabled to select that climate which, if not pre- 
cisely best for him, will at least prove approximately 
correct. The following description of the several va- 
rieties of climates, and notation of the good and bad 



THE TRUTH ABOUT CLIMATE 303 

points of each, with suggestions regarding the cases suit- 
able in each instance, is designed to aid each one in 
solving his own problem. 

STIMULATING CLIMATES 

Characteristics. Moderate or more decided dryness 
of the air, low atmospheric pressure and relatively low 
temperature, are characteristic attributes of stimulating 
climates. At high altitudes — that is, at elevations be- 
tween 3,000 and 7,000 feet (localities situated above 
8,000 feet being unsuited to the treatment of tuber- 
culosis) — where the air is usually cool or cold, as well 
as dry, the stimulating effect is very marked. Among 
the special advantages of high altitude should be men- 
tioned the brilliancy of the sunshine and the abundance 
of the chemical rays of the sunlight. Coupled with the 
fact that here sunstroke is almost unknown, these quali- 
ties render the climate of high altitudes ideal for the 
carrying out of the sun treatment. (In the previous 
lesson may be found a discussion of the advantages of 
sunlight, with detailed instructions for taking the sun 
baths.) 

This type of climate calls for strong reactive powers 
on the part of the sick person. Broadly speaking, it may 
be said that the more vigorous the patient, the greater 
the likelihood that a stimulating climate will prove best 
for him. 

Cases Suitable. Cases of early and moderately ad- 
vanced tuberculosis, barring complications and in the 
absence of factors having a contrary bearing, are as a 
class most suitable for treatment in stimulating climates, 
or at relatively high elevations. Patients in this group 
can usually be treated satisfactorily in any of the fa- 
vorable types of climate, but probably will obtain the 
best results in a moderately or decidedly stimulating 



304 LESSONS ON TUBERCULOSIS 

climate. Rule: Other things being equal, the less ex- 
tensive the disease, the more stimulating the climate, or, 
the higher the altitude (up to the limit mentioned above) 
that may be sought with safety. 

Objectionable Features and Contraindications. Even 
very sick persons are at first oftentimes markedly ex- 
hilarated, and apparently quite invigorated, on moving 
to a high elevation. Unfortunately, however, in some of 
these cases the return of strength lasts only a short 
time. By putting forth all its energy even the very 
feeble body may temporarily force itself to meet the in- 
creased demand, but it is not unlikely that in the long 
run the strain will prove so severe as to bring on ex- 
haustion. For very weak patients, therefore, I seldom 
recommend high altitudes. Nevertheless, even those in 
the far advanced stages of tuberculosis and who are 
extremely weak, sometimes succeed in avoiding the 
undesirable effects of altitude while securing all that it 
offers in the way of benefit. Thus, if more rest is taken 
than the case would otherwise require, the energy saved 
in this way may compensate for the heavier demands 
imposed by this type of climate. 

Patients of advanced years, and less frequently other 
persons, not rarely find that the rather sudden and pro- 
nounced temperature changes at high altitude provoke 
a decided irritation of the respiratory passages. The 
cough is sometimes aggravated and the quantity of 
sputum increased, and other distressing or injurious 
effects produced. These effects should be given careful 
consideration, and it may or may not be that the impetus 
given toward recovery in other ways will outweigh these 
disadvantages. 

Altitude versus Hemorrhage. A frequent question 
is: Should the patient who has at any time had a 
hemorrhage be moved to a high elevation ? Formerly it 



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THE TRUTH ABOUT CLIMATE 305 

was supposed that the chances of hemorrhage were 
greatly increased at high altitude, but experience has 
proven that unless the elevation be extreme — above 8,000 
feet — the risk is small, provided the proper precautions 
(which will be presently outlined) are taken. In this 
connection, the point to be remembered is that the time 
of danger is almost exclusively while the change is be- 
ing made, and for some days or weeks afterward. Dur- 
ing the period of transition from a low to a high 
elevation, or vice versa, the likelihood of hemorrhage 
occurring is somewhat increased, but after one has be- 
come thoroughly acclimated in the higher or lower alti- 
tude, as the case may be, the difference in the" outlook 
for hemorrhage is not great. In general, the patient 
need not consider himself barred from high altitudes 
solely because a long time previously he has raised a 
few mouthfuls of blood. Those who have ever had a 
large hemorrhage should make the change with extreme 
caution, if at all. 

Does Altitude Produce "Nervousness"? Again, 
patients fear that high altitudes will make them ex- 
tremely nervous, or if they are already nervous, that 
this will be aggravated. The fact should not be lost 
sight of that here and there an individual is so over- 
stimulated at a high elevation that very pronounced 
nervousness results ; but this is exceptional. If it be re- 
called that slight nervousness is a common symptom of 
tuberculosis, it is evident that if everyone who is at all 
nervous is prohibited from living at a high elevation, 
the benefits of altitude would be restricted to a very few. 
On the whole, a moderate degree of nervousness alone 
is not to be looked upon as overruling a trial of high alti- 
tude, if for other reasons deemed advisable. 

Will It Be Necessary for the Permanent Residence 
to Be Made at High Altitude? A frequent query is 

20 



306 LESSONS ON TUBERCULOSIS 

this : If health is recovered at a high altitude, will it be 
necessary for one to live thereafter at a similar eleva- 
tion? In most cases the answer is No. Nevertheless, 
now and then one comes across a person who, once ac- 
customed to the rarefied air at a high altitude, has dif- 
ficulty in making the change to a lower elevation. More 
rarely, it is found that it is altogether impossible to make 
the change down with safety, and that one is obliged to 
make one's home permanently at a high altitude. (This 
almost never occurs except in far-advanced cases or 
when serious complications on the part of the heart or 
other organs are present.) 

Here it seems advisable to again accentuate a point 
that has already been mentioned. When disagreeable 
effects are experienced on returning to a lower eleva- 
tion, the symptoms are not usually brought about by 
the change of altitude itself. They are usually due to 
the sudden resumption of work, or to the return to the 
old environment, which, with its many pulls and tempta- 
tions, is so likely to drag one back into faulty habits and 
methods of living. If one will continue to live rightly, 
there is small chance that serious harm will result from 
the change to the lower altitude alone.* 

At all events, the primary consideration is the com- 
plete restoration of health. From this standpoint, if in 
a given case the change to a higher altitude is war- 
ranted, only under extraordinary circumstances should 
one feel justified in holding back solely on the ground 
that some difficulty may perhaps later be encountered 
in becoming reacclimated at a lower elevation. 

* Elements in the old climate other than the factor of eleva- 
tion may, however, have a more important bearing on the ques- 
tion. To illustrate: Suppose one who has lived in the East 
recovers his health in some western state where both the 
summers and winters are milder. In this case, it would almost 
certainly prove advantageous, though not absolutely necessary, 
for the convalescent patient to make his permanent abode in 
some mild climate. The farther advanced the disease before 
the attempt was made to throw it off, the greater this advantage, 
as a rule. 



THE TRUTH ABOUT CLIMATE 307 

MODERATELY STIMULATING CLIMATES 

Characteristics. This type of climate is usually 
found at a moderate elevation (from 1,000 to 3,000 feet) 
and is characterized by a moderate range of tempera- 
ture, and fairly dry air. 

Cases Suitable. A moderately stimulating climate 
is suitable for the great majority of patients at the 
time that the true nature of their illness is first recog- 
nized (according to present-day methods as applied 
in the average case). 

MODERATELY RELAXING CLIMATES 

Characteristics. Low altitudes (up to 1,000 feet) ; 
where the air is either moderately dry or at most slightly 
moist; and moderately warm; furnish the conditions 
necessary for a mildly soothing and relaxing effect. 

Note: Contrary to a quite prevalent opinion, low 
altitude has no effect directly prejudicial to recovery. 
Of course, if the case is suitable for a higher elevation, 
the selection should be made accordingly. But if the 
case calls for a relaxing climate, there need be no hesi- 
tancy in seeking health even at sea level, provided all 
other climatic factors and health conditions are satis- 
factory. 

Cases Suitable. * Patients suffering from very ex- 
tensive tuberculosis or in late stages of the disease; 
patients of advanced years ; patients with serious heart 
or kidney complications, with very high blood pressure, 
or whose case is complicated by diabetes; those who 
are markedly short of breath; those who are decidedly 
sensitive to even slight weather changes; extremely 
nervous persons; and patients who have advanced tu- 
berculosis of the larynx — as a class, all of these require 
either a relaxing climate or one which is, at most, mod- 
erately stimulating. 



308 LESSONS ON TUBERCULOSIS 

Exception: Experience teaches that irrespective of 
the stage of the disease or of the other modifying fac- 
tors just enumerated, patients in this group are some- 
times met with who do not stand well even moderate 
heat. For such persons, heat is markedly enervating, 
and a cooler, more stimulating climate is as a rule pref- 
erable. 

Worth Remembering: In certain instances, those 
who at first require a mild, soothing climate, can, as 
they grow stronger, gain benefit by seeking a climate 
of the more stimulating type. If other things are suit- 
able, a step upward in altitude or climate at this time 
will often give one a further boost on the route to 
victory. 

Ocean Climates 

Characteristics. Ocean climates are characterized 
by high atmospheric pressure ; much humidity and fre- 
quent fog ; a moderate amount of sunshine ; considerable 
wind ; and— over the ocean — by the practical absence of 
germs; the temperature varying roughly according to 
the latitude. The salt air, through the sense of smell 
or otherwise, and the wind, add to the stimulation. On 
the whole, depending upon whether the temperature is 
high or low, the general effect of the ocean climate varies 
from marked stimulation to extreme relaxation. How- 
ever, in the temperate zones, where the temperature re- 
mains within reasonable bounds, the effect is ordinarily 
moderately relaxing or moderately stimulating. 

Cases Suitable. So far as the stage of the disease 
alone is concerned, no case creates a definite call for 
this type of climate. Some of the patients classified as 
requiring a moderately relaxing climate will do well 
in an ocean climate ; whereas for others of this group the 
somewhat drier type of moderately relaxing climate (see 



THE TRUTH ABOUT CLIMATE 309 

under Desert Climates below) is preferable. Coast 
climates have been highly recommended for children; 
especially, for the prevention of tuberculosis, and for the 
treatment of tuberculosis of the bones and lymph glands 
(forms of the disease which commonly occur during 
the earlier years of life). To a less extent, ocean or coast 
climates have been advised in very slight, beginning tu- 
berculosis in adults; more especially if the disease has 
not yet progressed to the "open" stage. Inasmuch as 
the local effect of the air on the lungs is virtually ab- 
sent in this group of cases, the chance that the moist 
air will work injury is reduced. Nevertheless it is 
probable that the great majority of grown persons suf- 
fering from even early tuberculosis will fare better at 
some inland locality where the air is relatively dry and 
at least moderately stimulating. 

For patients who suffer from tuberculosis of the 
larynx and who have failed to improve elsewhere, the 
moist air of the coast in warm latitudes may prove sooth- 
ing and beneficial. 

Disadvantages. Aside from strictly climatic objec- 
tions applying to coast resorts, the beach has the ad- 
ditional drawback of offering on every hand the 
temptation to take up some harmful amusement or 
sport, of which perhaps the most dangerous is surf- 
bathing. That indulgence in the strenuous pastime 
of jumping the breakers has wrecked the hopes of 
many a patient with promising outlook is beyond 
dispute. For this reason, those who are contemplat- 
ing a stay at the coast should not only steel them- 
selves beforehand against yielding to this desdre, but 
should make it a paint to keep away from the more 
popular and crowded resorts. 

For the prevention of tuberculosis and for the treat- 
ment of tuberculosis in childhood, less attention need 



310 LESSONS ON TUBERCULOSIS 

be given to these features. For some of these little 
patients rest is not quite so essential (for example, for 
those who suffer from tuberculosis of the lymph 
glands) ; and the pleasant surroundings furnish suitable 
attractions and diversions without which it is almost 
impossible to keep the little folks contented. 

Summing up, it may be said that while an ocean cli- 
mate is not commonly to be recommended (save for 
children, as just mentioned), it is equally true that 
for a few patients a climate of this variety is more suit- 
able than any other, altho it is difficult to lay down on 
paper a definite rule for picking out the cases in ad- 
vance. The main lesson to be learned from a study of 
ocean climates is this : If for one reason or another, cir- 
cumstances make it necessary for the sick person to make 
his home at the seaside, he may do so, resting easy in 
the knowledge that while the climate may not be pos- 
sibly the best for him — at worst the influence will prob- 
ably be less harmful than he has previously supposed. 

The Question of Sea Voyages. In past years sea 
voyages were frequently advised. Without doubt, a 
few favorable results were achieved in this manner, but 
damage was more frequently wrought. Among the ob- 
jections to a sea voyage must be reckoned rough weather, 
with the consequent confinement indoors; seasickness; 
in some cases, the poor quality of the food; and the 
difficulty of obtaining real physical rest — when the pre- 
vailing conditions make the opposite course the easier. 
To some individuals a trip on the ocean does afford one 
valuable element, the opportunity for thorough and 
complete mental relaxation. In other cases, however, 
the contrary effect is noted, the continued monotony day 
after day furnishing just the opportunity for brooding 
and worry. To-day, in the light of accumulated knowl- 
edge as to better methods of treatment, with the 



THE TRUTH ABOUT CLIMATE 311 

emphasis on rest, it is apparent that a sea voyage is 
rarely to be advised. 

Desert Climates 

Characteristics. Among the usual attributes of 
desert climates are: almost constant sunshine and ex- 
treme dryness of the air (both factors contributing to 
the remarkable purity of desert air — to its nearly com- 
plete freedom from microorganisms) ; the occurrence of 
wind and sand storms at greater or less intervals ; high 
atmospheric pressure; and a temperature during the 
hot season which is very debilitating for most persons, 
but which in places is just sufficient to make the winters 
warm and comfortable. In summer, save in very excep- 
tional cases, desert climates (at low altitude) are en- 
tirely unfitted to the treatment of tuberculosis. During 
the winter, however, localities having a climate of this 
type, especially those spots favored by being somewhat 
protected by the desert storms, furnish a variety of 
"good" climate a little different from any yet so far 
described, wherein just the elements are combined to fit 
the needs of a certain group of patients. In winter, a 
desert climate is as a rule either mildly stimulating or 
moderately relaxing. 

Cases Suitable. Those persons whose condition calls 
for a mild soothing effect or for a climate which is at 
most only moderately stimulating, sometimes find the 
happy medium in the desert climate. For example, 
some patients need moderate stimulation, but discover 
that even the medium altitude at which a mildly 
stimulating atmosphere is ordinarily found, does not 
agree with them. Others, who require a moderately 
relaxing climate, find that in a good many of the lo- 
calities where a climate of this type obtains, the rela- 
tively moist air is an objectionable feature. In the 



312 LESSONS ON TUBERCULOSIS 

desert climate, both of these groups of patients may 
perhaps find the exact combination of climatic elements 
that they require. 

Disadvantages. Aside from the distressful effect of 
the extremely dry desert air on certain patients, 
previously spoken of, the desert has other objectionable 
features as a place for recovery. Among these are: 
strong winds and sand storms (altho of course these 
do not occur in all parts of the desert) ; the isolated 
position of some of the desert resorts, which makes 
it quite difficult or impossible to obtain wholesome food, 
suitable accommodations, expert medical advice — and 
the like. These points should be carefully investigated 
before the change of residence is made. 

Items to Be Carefully Weighed 

From the foregoing paragraphs it is seen that the in- 
dications for climates of various types overlap to some 
extent, and are by no means hard and fast. So the 
selection must be controlled by a careful consideration 
of several important auxiliary or secondary factors — 
factors which in the end may prove decisive. These 
will now be taken up separately: — 

1. The accessibility of the place one has in mind; 
the opportunity for obtaining proper food, for securing 
the services of a physician who has tuberculosis judg- 
ment, the probability of obtaining a capable nurse — if 
required ; for those patients who must work — the chance 
of finding suitable employment; and the pleasantness 
and general character of the surroundings, including 
the possibility of obtaining recreation without at the 
same time doing oneself harm — all are matters for 
careful thought. 

Relative to the last point, it is obvious that a resort 
situated right in the heart of the mountains, where 



THE TRUTH ABOUT CLIMATE 313 

walking necessarily means trail climbing, is unsuited to 
those for whom exercise of this sort is inappropriate; 
and it is to be remembered that such exercise is inap- 
propriate for most patients, at least for a long time. 
(Of course, this objection does not apply to those high 
altitudes where the lay of the land is comparatively 
level.) 

2. A valuable hint can sometimes be obtained from 
one's past experiences. When the decision is in doubt, 
the fact that previously one has enjoyed better health in 
winter than in summer, or the reverse; or that in 
former years high altitude has or has not agreed with 
one; or that some particular weather change is known 
to have produced a bad effect — may aid in the solu- 
tion of the problem. However, the mistake should be 
avoided of depending too fully on the fact that such 
and such a climate has agreed with one in the past. 
Such an effect should of course be given due considera- 
tion, but it should also be understood that one who is 
ill may respond to a particular climate somewhat dif- 
ferently than when well. 

3. There can be no question that the outdoor life 
is more comfortable in a warm, than in a cold climate. 
For many persons, too, warmth makes for contentment, 
thereby favoring relaxation of body and mind. As the 
things which are easy to do, and which fall evenly into 
line with one's everyday desires, are more likely to be 
done than if they are disagreeable tasks, it goes with- 
out saying that the rest and fresh air treatment is oft- 
times much more effectively carried out in a warm, 
balmy atmosphere, where languor is natural and it is 
easy to be lazy. 

A Common Error. If the fullest measure of value 
is to be obtained from climate it is imperative for one 
to live continually in the open air. I have known many 



314 LESSONS ON TUBERCULOSIS 

patients to travel long distances seeking a favorable 
climate, then on reaching the new locality to remain 
indoors most of the time ; not indoors on a well-arranged 
sleeping porch, but within an ordinary house where 
the windows were open only a little way. Yet these 
persons expected to get complete benefit from climate! 

Practically speaking, a suitable climate means suit- 
able air, and it is pure folly to expect results from 
even the best of climates unless one actually LIVES 
in the new atmosphere. 

At best, outdoor living in a decidedly cold climate 
makes it necessary for the patient to become somewhat 
of an exile, especially if he requires considerable rest; 
and necessitates much cumbersome bundling up, and 
weighting down of the body with heavy clothes and 
protective coverings — all of which is rather disagree- 
able. All in all, it is often difficult for the physician to 
persuade his patient to persist in the routine in the 
face of distasteful weather conditions. True, by sheer 
force of will many patients make themselves stay out of 
doors even tho this means virtual isolation from their 
friends ; but there are many others who will not do so. 
In this regard, the saying, "The good use of a bad 
climate is better than the poor use of a good climate,' ' 
may be usefully stamped upon the memory. Of course 
it is even better to make good use of a good climate. 

Some Favored Spots 

How often the health seeker starts for the perhaps 
distant state with only a very general and hazy idea 
as to his exact destination — intending to choose the pre- 
cise locality for his future home after arriving on the 
ground. The result is that he draws heavily upon his 
rather scanty store of energy, and wastes time and 
money in needless travels here and there before finally 



THE TRUTH ABOUT CLIMATE 315 

settling down. How often it comes about that his 
chances for recovery are in this manner lost forever. 
For this reason — to the end that the journey may be as 
direct as possible — it is highly important that the suf- 
ferer know where he is going before he sets out. Ex- 
prest differently, this means not only that one should 
have a previous acquaintanceship with the general char- 
acteristics of the new climate, but should have in mind 
a particular town or locality for which one is bound. 

In the succeeding paragraphs will be found a fairly 
complete list and a brief description of the localities 
that enjoy a greater or less renown as places for re- 
cuperation. It goes without saying that space will not 
permit even the bare mentioning of all the localities fa- 
vored with an especially wholesome climate. Notice 
can be taken only of the more prominent characteristics 
of some of the more famous resorts, situated for the 
most part in this country. Altho there are, of course, 
many other localities having just as good climates, 
it is usually safer to follow the beaten path— so to 
speak — to stick to those places that are better known, 
unless one has received positive assurance that satisfac- 
tory accommodations, medical service, etc., are obtain- 
able elsewhere. 

Preliminary to making the choice let it be under- 
stood, also, that an absolutely ideal climate does not 
exist. Every locality has its drawbacks, each climate 
has some disagreeable days. One can only aim to 
select the locality in which the general trend of the 
weather conditions is favorable during the greatest 
portion of the time. 

NEW ENGLAND AND EASTERN STATES 

Among those who live in the East are doubtless many 
for whom a long trip is impracticable. Fortunately, a 



316 LESSONS ON TUBERCULOSIS 

fair number of these persons may find at least mod- 
erately favorable climatic conditions near at hand. In 
the eastern and New England states there are many 
accessible places where a more or less stimulating 
climate is to be had during at least part of the year. 
The whole of this section of beautifully wooded country 
affords a most fitting setting for the wealth of streams 
and mirrored lakes — a combination that offers a wide 
range of diversions and pastimes for those who are in 
condition to avail themselves of these opportunities. 
For example, in the interior portion of Maine as well 
as in the mountainous region of New Hampshire, the 
air is quite stimulating despite the fact that it contains 
a considerable percentage of moisture. However, the 
rather too high humidity is to some extent com- 
pensated for by the moderate altitude and rather north- 
ern latitude, so that the summers on the whole are com- 
fortably cool, and the air mildly and pleasantly brac- 
ing — the odor of the pines contributing to the stimu- 
lating effect. The winters are too rigorous for the great 
majority of persons ill of tuberculosis. 

ADIRONDACK DISTRICT. Situated at an average 
elevation of 2,000 feet, this region has a climate that is 
ordinarily at least mildly stimulating during all sea- 
sons. During the winter the air is intensely cold but as 
a rule dry and crisp, and therefore decidedly bracing; 
the summers are usually moderately stimulating, altho 
sometimes a long hot and humid, oppressive and relax- 
ing wave in the weather occurs. Withal, there are 
many cloudy days, considerable fog, snow and rain, 
and frequent, pronounced weather changes. 

The numerous sanatoria and tuberculosis camps scat- 
tered throughout this stretch of picturesque countryside 
constitute perhaps its most valuable asset for the health 
seeker. At Trudeau, N. Y., not far from the well-known 



THE TRUTH ABOUT CLIMATE 317 

resort, Saranac Lake, is the famous Trudeau Sanatorium 
(Adirondack Cottage Sanatorium) ; while not far dis- 
tant are other sanatoria of various sizes, besides a large 
number of boarding places where the invalid may obtain 
suitable accommodations. 

Sea Breeze, near New York City, which furnishes a 
rather typical example of the eastern ocean climate, has 
obtained fame as a resort for the treatment of children. 

PENNSYLVANIA. In the highlands of Pennsyl- 
vania is found a climate with the same general char- 
acteristics as the climate of the New York Adirondacks. 
At White Haven are several excellent modern sanatoria 
for patients of various means. At Mont Alto is the 
immense institution conducted by the state, branches of 
which are located at Cresson and at Hamburg. 

NEW JERSEY. Following the usual rule, the 
climate of the northern and more elevated portion of 
New Jersey is cooler, drier, and more stimulating than 
that of the southern and lower part, where the weather 
is more even, the air moister and the climate as a 
whole milder. Morristown and Summit, at elevations 
of about 500 feet, have a year-round climate which is 
moderately stimulating in winter and less stimulating 
or even slightly relaxing in summer. On the other 
hand, Lakewood, 60 feet above sea-level, has a more even 
and milder climate of the coast variety. At Morris 
Plains, near Morristown, there is a small tuberculosis 
hospital supported by the county, but beyond this, 
provisions for the pulmonary invalid are scanty indeed 
in the three places mentioned. 

THE SOUTHERN STATES 

THE CAROLINAS. Asheville, N. C, 2,555 feet 
above sea-level, has a year-round climate of the moder- 
ately stimulating type. The weather is fairly equable 



318 LESSONS ON TUBERCULOSIS 

and the atmosphere moderately dry; the summers cool 
and the winters cold. Among the advantageous fea- 
tures are the beautiful surroundings, the provision for 
medical care, at least two well-equipped sanatoria, and 
a number of desirable boarding places for the sick. 
Southern Pines, N. C, altitude about 700 feet, has a 
climate similar to that of Asheville, but milder and less 
stimulating. It has one sanatorium. Aiken, 8. C, at 
an elevation of 500 feet, has a moderately relaxing 
climate. Sunshine is abundant and the air moderately 
dry. The winters are mild, but the summers are hot 
and debilitating. Aiken has a good sanatorium, for 
men only in reduced circumstances. Charleston, S. C, 
at the coast, has a pleasant, warm, moist, relaxing 
climate, but has the disadvantages common to all large 
cities, as well as the objection of having no tuberculosis 
sanatorium. 

GEORGIA. Augusta, Ga., and North Augusta, just 
across the Savannah River, have a delightful winter 
climate resembling that of Aiken, altho the air is per- 
haps a little moister, and the weather on the average 
slightly warmer. The accommodations are good, altho 
special provisions for the pulmonary invalid are few. 
Savannah, Ga., has the same type of climate and the 
same objections as Charleston, S. C. At Atlanta, Ga., 
the weather is again a little cooler and in winter occa- 
sionally very cold — and in turn more bracing; in sum- 
mer it is sometimes quite hot and oppressive. Atlanta 
has a large municipal free sanatorium. Thomasville, 
at an elevation of 300 feet, has an excellent winter 
climate of the relaxing type — warm and moist ; but the 
summer weather is too hot for most patients. 

FLORIDA. A narrow strip of lowland extending 
into a near-tropical sea — Florida has an equable, warm 
and moist, relaxing climate — of the marine type. A 



THE TRUTH ABOUT CLIMATE 319 

land of entrancing scenery of an unusual variety, and 
of perpetual summer, its climate is noted for its mild- 
ness and evenness, the temperature changing very lit- 
tle the year round. Among the objectionable features 
are the numerous insects, which in many places are 
veritable pests. In former years when mildness was 
the main element sought in climate, many persons af- 
flicted with tuberculosis sought to rescue their health 
through a visit to Florida. Now that it is known that 
better results are obtained if the individual is given 
stimulation in proportion to his ability to respond, 
Florida can less often be recommended. However, if 
care be used in choosing the exact locality, many places 
may be found in Florida suitable all the year, but espe- 
cially during the winter, for such patients as need a 
climate of this type — provided they understand not only 
how to care for themselves, but are able and willing to 
do so. There are numerous pleasure resorts with ex- 
cellent accommodations, but sanatoria or other places of 
lodging suitable especially for the pulmonary invalid 
are few. At Port Orange there is a private sanatorium, 
at Jacksonville and Miami the counties have provided 
tuberculosis pavilions, and at Tampa there is a county 
tuberculosis camp. 

THE BERMUDA ISLANDS. Altho the Bermuda 
Islands are a British possession, because of their com- 
parative nearness to the United States and their popu- 
larity, it may not be out of place to remark that the 
climate of the Bermudas is very similar to that of 
Florida, and in a general way, suitable for the same 
small class of patients. Note: The passage to the 
Bermudas is often rough and disagreeable — and this fact 
alone may call for a change of plan. 



320 LESSONS ON TUBERCULOSIS 

THE WESTERN STATES 

In the western part of the United States is found a 
wide variety of climates, including almost every type 
useful in tuberculosis, but the air of this vast region 
is pre-eminently noted for its invigorating effect. Owing 
to the quite general elevation of this section, the atmos- 
pheric pressure is on the average relatively low and the 
air comparatively dry — conditions which, taken to- 
gether, make for comfortable summers and for winters 
that vary from warm to cold, according to the exact 
locality, the combined result being an excellent climate 
of the moderately stimulating, or decidedly stimulating 
type throughout the year. 

COLORADO. The high elevation of Colorado, and 
its moderately dry air and clear skies, furnish the basis 
of a climate that is remarkably stimulating and bracing. 
The summers are delightful — neither too warm nor too 
cold. The winters, however, are decidedly cold; but 
withal, the snappy, biting, dry air, tends to instil with 
vigor those who are sufficiently rugged to respond. 
Bearing out the rule of high altitudes, the daily tem- 
perature range is rather wide; the nights on even the 
warmest days are nearly always pleasantly cool. On 
the whole, the climate is as nearly an ideal one of its 
kind as it is possible to find, the inspiration of a grand 
and magnificent scenery contributing much to the sum 
total of health promoting value. 

Denver, one mile above sea level, has an excellent 
climate — its only objectionable feature being the dust- 
laden winds which sometimes prevail in the spring and 
fall. In former years Denver was held in high repute 
as a health resort, but now has all the disadvantages of 
a large city, and is therefore not a very desirable place 
for the invalid to make his home. In its less crowded 



THE TRUTH ABOUT CLIMATE 321 

outskirts, somewhat more favorable conditions may be 
found. Denver has a number of well-equipped, up-to- 
date sanatoria, for both the well-to-do and those of 
limited means, as well as a number of attractive board- 
ing places for tuberculous persons. 

Colorado Springs, about one thousand feet higher 
than Denver, has all the climatic advantages of Denver 
and is largely free from the objectionable features asso- 
ciated with a large city. The general trend of the 
weather is a little cooler. A disadvantage is the dust 
and wind storms, which are more bothersome than in 
Denver. The several sanatoria and other accommoda- 
tions for the invalid are excellent. 

Manitou, situated five miles from Colorado Springs 
at an elevation of 6,000 feet, has a practically identical 
climate — with the advantage that, due to its more 
sheltered position at the foot of Pike's Peak, wind is 
less frequently a source of annoyance. Manitou is a 
small village with scanty accommodations for the in- 
valid, altho it has one sanatorium. Glenwood Springs, 
5,200 feet above sea level, is sometimes recommended. 
It has a good hotel, but no special accommodations for 
those ill of tuberculosis. Pueblo, lying at an elevation 
of 4,700 feet, has a good climate, altho the summers are 
rather hot ; but as its accommodations are very limited, 
it is not ordinarily, recommendable. 

Rocky Mountain Park, a half -day's ride from Den- 
ver, lying at an approximate elevation of 7,000 feet, has 
both a climate and a wonderful scenery that rival those 
of Switzerland. At Estes Park, a village situated at 
the entrance to Rocky Mountain Park, suitable accom- 
modations and the services of competent physicians are 
obtainable. 

NEW MEXICO. Situated at an average elevation 
of about 5,000 feet, New Mexico (especially its 

21 



322 LESSONS ON TUBERCULOSIS 

northern part) is favored with a climate that is very 
much like that of Colorado. Sante Fe, Los Vegas, and 
Albuquerque, each situated at an elevation of between 
five and seven thousand feet, have climates resembling 
that of Denver, the weather at Albuquerque being a 
little warmer both in summer and winter. Santa Fe 
has two sanatoria, Los Vegas one. Albuquerque has 
four or five sanatoria, with other accommodations for 
the sick. 

In southern New Mexico, at Fort Stanton and Fort 
Bayard, the homes respectively of federal marine and 
army sanatoria, and at Silver City — all three situated 
at any altitude around 6,000 feet, the climate is excel- 
lent throughout the year, the summers pleasantly cool, 
the winters cold. Silver City has two sanatoria and 
very good accommodations. Denting, altitude 4,300 
feet, also furnishes a good winter climate, but its sum- 
mer weather is too hot for the comfort and well-being 
of most patients. 

TEXAS. El Paso, at a medium elevation, has a 
winter climate similar to that of Deming. Its sum- 
mers are warm and occasionally quite hot. El Paso has 
five sanatoria. San Antonio, situated only 680 feet 
above sea-level, has a milder, more even and rather re- 
laxing climate in the winter; its summer climate is 
decidedly hot and is not as a rule to be recommended. 
San Antonio has two private sanatoria, and also a free 
tent colony conducted by the county. 

ARIZONA. This state has on the whole a dry, in- 
vigorating climate. Its summers are in most places hot- 
ter and its winters correspondingly cooler than those 
of Colorado and New Mexico, altho comparatively cool 
summer weather is found in the more elevated district 
of northern Arizona. Prescott, 5,200 feet, and Flag- 
staff, at 7,000 feet above sea level, are usually suitable 



THE TRUTH ABOUT CLIMATE 323 

for outdoor living during the entire year, altho some- 
times the summer weather is disagreeably hot. Pres- 
cott has three excellent private sanatoria, while at Fort 
Whipple, on the immediate outskirts of the city, is 
situated an immense government sanatorium. The ac- 
commodations are not good at Flagstaff. 

Phoenix, altitude 1,100 feet, has relatively mild, delight- 
ful winters, a particular virtue of its climate being the 
almost complete absence of dust and wind— disagreeable 
features which are ordinarily coupled with this type 
of climate. It has several sanatoria and other accom- 
modations for the health seeker. Its summers are in- 
tensely hot, fairly humid, and on the whole debilitating, 
and are not recommended. 

Tucson, situated at an elevation of 2,400 feet, has a 
nearly ideal winter climate similar to that of Phoenix, 
but drier and more stimulating. The summers are quite 
hot, and for most persons undesirable. It has two 
private sanatoria exclusively for tuberculosis, one private 
sanatorium with a special tuberculosis department, a 
U. S. public health service hospital for tuberculosis, and 
other accommodations for those who are ill. 

Yuma, right in the heart of the desert and only 140 
feet above sea level, furnishes a typical example of the 
desert climate. So far as the climate alone is con- 
cerned, the winters are suitable for patients requiring 
a decidedly dry, warm, sunny, moderately stimulating 
or mildly relaxing atmosphere, but the summers are 
almost unbearably hot. There are no sanatoria and few 
special accommodations for the sick. 

CALIFORNIA. A distinction is to be drawn be- 
tween the climate of the northern half of California 
and that of the southern portion. 

In northern California the general trend of the 
weather is colder than in the southern part of the state, 



324 LESSONS ON TUBERCULOSIS 

and near the coast there is considerable wind and the 
air is quite damp. Moreover, the weather is exceedingly 
changeable and there are many disagreeable, blustery 
days. Taken as a whole, the climate of the coast resorts 
in this part of the state is not the best, altho it is 
much more favorable than the climate of many other 
parts of the United States. Belmont, Redwood City and 
Los Gatos, all within a short distance of San Francisco, 
have each one first-class private sanatorium; and at 
Palo Alto, near by, there is a Public Health Service 
Hospital for tuberculosis. 

Farther inland, the weather is calmer, the air drier, 
and the climate in general milder, tho still quite stimulat- 
ing. It is well suited to patients with fairly strong re- 
active powers ; but, unfortunately, this part of the Oolden 
State is as yet relatively unsettled and undeveloped, 
and therefore largely unsuitable for the home of the 
invalid. There are, however, a few localities in this 
section where satisfactory accommodations are to be 
had. Of these, Colfax, elevation 2,400 feet, situated 144 
miles east of San Francisco, has an excellent sanatorium 
in connection with an open-air school for tuberculosis; 
and Alta, situated about the same distance from the 
coast, and at a moderate elevation, has one sana- 
torium. 

SOUTHERN CALIFORNIA. The climate of south- 
ern California is, in general, mild and moderately stimu- 
lating, yet one can live out of doors in all seasons with 
real comfort — a combination found in few other places. 
To the merits of the climate is added the charm of a 
beautiful and extraordinarily diversified scenery. 
Broadly speaking, the climate of this wonderland is 
characterized by moderateness — the winters as a rule 
being just pleasantly cool ; the summers comfortable. A 
noteworthy feature is that the nights following even 



THE TRUTH ABOUT CLIMATE 325 

the hottest days are nearly always cool and refreshing. 
The sunshine is abundant ; yet sunstroke is practically 
unknown. The air is moderately moist or moderately 
dry, roughly according to the distance from the ocean 
and the elevation. 

Los Angeles, elevation 287 feet, is rather too near the 
coast (twenty miles) for the best conditions, and has 
a good many foggy and cloudy days, besides the in- 
herent disadvantages of a large city. There is one ex- 
cellent, strictly modern semi-charitable sanatorium. In 
addition, in the San Fernando Valley, twenty-five miles 
to the north, Los Angeles county maintains an immense 
institution for the care of the tuberculous poor. A num- 
ber of physicians who have devoted years of study to tu- 
berculosis are to be had in Los Angeles. (At San Fer- 
nando there is a sanatorium conducted by the Indepen- 
dent Order of Foresters.) 

Some nine miles farther inland, at an elevation of 
some 800 feet, is beautiful Pasadena; near by and also 
as one passes eastwardly up the San Gabriel valley are 
found many delightful spots, the air in general be- 
coming drier and the altitude higher as one goes farther 
from the ocean. Some of these smaller places are: 
Altadena (adjoining Pasadena on the north), which has 
a modern, semi-charitable sanatorium, Sierra Madre, 
Monrovia — the latter having an excellent private sana- 
torium, as well as an inviting cottage service for the 
sick with expert medical attendance — Duarte, where is 
located a Jewish Relief Sanatorium, Pomona, Ontario, 
Riverside, San Bernardino and Redlands; the altitude 
increasing slightly (up to 2,500 feet) and the air 
becoming drier and warmer, as one reads to the end of 
the list. 

Banning, twenty-five miles east of Redlands and about 
one hundred miles from the ocean at an altitude of 



326 LESSONS ON TUBERCULOSIS 

2,400 feet, has a somewhat more stimulating winter 
climate, and clearer skies throughout the year. Owing 
to the distance from the ocean and to the diverting in- 
fluence of the nearby mountain ranges on the air cur- 
rents, fog, which sometimes hovers disagreeably over the 
valley points, seldom reaches Banning. On the other 
hand, due to the proximity to the desert, the air is in all 
seasons drier and in summer slightly warmer, yet the 
coast is near enough so that the dryness is usually kept 
within moderation, and the dryness itself minimizes 
any discomfort from the few degrees added to the tem- 
perature. During the winter fairly strong east winds 
are rather frequent, which are an objectionable feature, 
but withal the cool, dry air is decidedly bracing. Ban- 
ning has three excellent sanatoria, and a well conducted 
boarding place and bungalow service for the sick. 

Beaumont, near Banning, has a similar climate, but 
no special accommodations for tuberculous persons. 
Hemet, in a valley at a somewhat lower elevation a few 
miles southeast, has evener, warmer winters, and more 
intense heat in the summer. It has one modern sana- 
torium. 

Palm Springs, though but twenty-three miles east of 
Banning, yet has an entirely different climate — a climate 
of the desert variety about as good as can be found 
anywhere. Situated at an elevation of 400 feet, this 
little hamlet is virtually an oasis in the desert. Pro- 
tected from the harshness of the main or real desert by 
sheltering mountains, its weather is toned down to a de- 
gree that eminently fits it as an excellent winter resort 
for persons who require an even, warm, moderately dry 
atmosphere. The summers at Palm Springs are very 
much too hot, save in very unusual cases. Palm Springs 
has one excellent hotel with open-air bungalows to 
accommodate its guests, and there are several less pre- 



THE TRUTH ABOUT CLIMATE 327 

tentious hotels and boarding places. Special provisions 
for those who are manifestly ill are, however, rather 
limited. Expert medical counsel is to be had. 

San Diego, situated down the coast near the Mexican 
border, has a climate agreeably tempered by its more 
southern location and by the ocean. The weather is 
very even; the winters pleasantly warm, the summers 
cool. The air is rather humid, and, as is commonly true 
at the coast, there is considerable fog during certain sea- 
sons. Compared to Los Angeles, the climate of San 
Diego is less stimulating, and is sometimes classed as 
moderately relaxing. San Diego county has one public 
institution and a free open-air colony for those afflicted 
with tuberculosis, and in the foothills at Alpine, thirty 
miles to the east, where the air is drier, there is a well- 
equipped sanatorium. 

Santa Barbara, also on the ocean front, but about one 
hundred miles to the north of Los Angeles, has a climate 
similar to that of San Diego, altho less equable. Its 
summers are a little warmer, its winters slightly cooler. 
Santa Barbara has one semi-charitable sanatorium. 

FOREIGN RESORTS 

Space prohibits any discussion of the merits of the 
many places abroad suitable for the health seeker. In 
Europe, the stimulating and bracing climates are as a 
rule found at the higher altitudes, notably in Switzer- 
land and Germany; the more soothing and relaxing 
atmospheres, along the Riviera. It may be stated, 
however, that the great majority of patients would do 
better by staying in America, not only because of the 
objection to a long sea voyage, but because just as fa- 
vorable climates of all varieties are to be had in this 
country. 



328 LESSONS ON TUBERCULOSIS 

Where a Comprehensive List op Sanatoria with 
Other Information May Be Obtained 

In the foregoing pages, in connection with the dis- 
cussion of each locality, the endeavor has been to record 
briefly the presence or absence of accommodations for 
the health seeker. Those who wish a more detailed 
description of the institutions mentioned, or who desire 
information concerning other institutions, and the like, 
situated in any state, town or place not mentioned 
herein, should obtain Pamphlet No. Ill, a Directory of 
Sanatoria, Hospitals and Day Camps for Tuberculosis, 
issued by the National Tuberculosis Association, 370 
Seventh Ave., New York. In this publication will be 
found a comprehensive list of the available sanatoria, 
hospitals, camps, boarding places and preventoria for 
the treatment or prevention of tuberculosis, with nota- 
tion of the class of cases accepted, the rates, and other 
useful inf ormation. 

The Importance op Care When Changing 

Climates 

The patient who has decided to transfer his place of 
residence, before setting out should stamp on his memory 
the fact that after he has been in the new locality only 
long enough to recuperate from the immediate effects 
of the journey, he will very probably notice that he 
has already begun to feel stronger than before. Irre- 
spective of the nature of the climate, and perhaps fol- 
lowing on a mere change of environment, an apparently 
decisive change for the better is likely to occur, altho 
this effect is more noticeable if the transition has been 
from a relatively low to a high altitude. The primary 
feeling of exhilaration and stimulation is often so pro- 
nounced that the invalid is led to overestimate his 
strength and to undertake tasks far beyond his real 



THE TRUTH ABOUT CLIMATE 329 

power. For a time, by using all its latent energy the 
body is able to meet the increased demand ; then comes 
the reaction — exhaustion; in its train there not rarely 
follows a relapse, which may be prolonged indefinitely, 
even permanently. 

In order to guard against mishap, every means 
should be used to make the change as gradual and easy 
as possible. For some weeks afterward the patient 
should take a greater amount of rest than his case 
would otherwise call for (unless of course he is al- 
ready at complete rest), no matter how well he feels 
nor how great the temptation to do more. Redoubled 
watchfulness during this period may save months or 
years of trial. 

The following specific rules are designed to aid the 
sick person in making the journey safely. The rules 
may be modified as circumstances warrant to meet the 
precise conditions present in each case. In any event, 
however, unless the patient is without fever (which 
means that the daily temperature does not go 
above 98.6° P., except as noted in Lesson V. p. 132), 
and unless in addition all other evidence indicates that 
the illness is very slight, it is seldom advisable to lessen 
the restrictions materially. 

1. Before starting, the exact destination should be 
determined on, if at all possible. 

2. If practicable, the accommodations should be en- 
gaged in advance. 

3. Read carefully that portion of Lesson IX devoted 
to the topic, Rest. At all stages of the journey follow 
as closely as possible the instructions given therein for 
obtaining rest. Bear in mind that the unwonted nerve 
strain and the more or less unavoidable exertions in- 
cident to the journey, put an unusually severe tax upon 
the resources. Make it a point, therefore, during the 



330 LESSONS ON TUBERCULOSIS 

ride to take advantage of every opportunity for secur- 
ing complete rest and repose. Aim to be even more 
quiet and at ease than if at home, in order to offset the 
extraordinary wear and tear on the bodily energy, 

4. An attendant should accompany the invalid to 
minister to his comfort and assume all the responsibili- 
ties. In lieu of this, arrangements should be made with 
the porter or conductor to keep a watchful eye on the 
patient, and to arrange for a suitable vehicle to meet 
him at the end of the journey. 

5. The sick person should be taken to the depot in 
such a manner as will call for the least amount of effort 
on his part. An ambulance or a taxicab may be made 
use of, or some substitute conveyance employed. The 
patient should be assisted aboard the train; if he has 
been confined to his bed or chair he should be carried. 

6. If the finances permit, a stateroom, or at least 
a section, should be reserved for the sole use of the pa- 
tient and companion. Once aboard the train, the patient 
should rest reclining either on a cot or in the berth, and 
endeavor to relax himself completely, both bodily and 
mentally. 

7. At both the beginning and end of the journey, 
the checking and transportation of the baggage, and 
other similar items, should be delegated to the attendant 
or some other person. 

8. Arrived at the new locality, the invalid should 
be gently lifted or helped into a suitable conveyance 
(depending upon circumstances), and if possible, taken 
directly to his new abode. 

9. If house hunting must be a part of the program, 
this duty should fall to someone else. In the interim, 
the patient should make himself as comfortable as pos- 
sible in a hotel; or, if need be, sit quietly in the wait- 
ing room of the station. 



THE TRUTH ABOUT CLIMATE 331 

10. If the journey is made despite the fact that 
color has recently appeared in the sputum, all rules 
should be lived up to the more rigidly. Also, preferably, 
in this event (and certainly if much blood has been ex- 
pectorated, or if the patient has fever, or shows in any 
way that he is quite sick), during all stages of the jour- 
ney from the time that he leaves home until he arrives at 
his new abode, the patient should recline upon a cot. 

11. If, while on the way, the patient should spit 
blood, if not already recumbent he should lie down im- 
mediately, remain absolutely quiet, and avoid move- 
ments of all kinds. In this way a severe hemorrhage can 
nearly always be averted. 

Is a Frequent Change op Climate Desirable ? 

In another paragraph the statement has been made 
that a change of climate, a change of environment, or in 
fact any change, is ofttimes productive of good results. 
In turn, there come to mind the questions: Would it 
not be a good plan to make a change of residence quite 
frequently? Is it not possible that as one tires of the 
surroundings, the good effect almost ceases? As the 
old scene and environment begin to wear on one, may 
it not be that by breaking the monotony and staleness, 
and lending an effort of continual newness, a change of 
residence now and then would prove of immense benefit ? 

In seeking for the answers, there are several im- 
portant items to consider. Altho the primary feeling 
of well-being resulting from a change of almost any 
sort is worth a good deal (provided the patient does 
not give way to the feeling of exhilaration and over-task 
himself at this time) nevertheless this can hardly be 
looked upon as the real influence of climate. Certainly 
it is not its most important influence. 

The most valuable effect of climate is the building up 



332 LESSONS ON TUBEECULOSIS 

of the fighting resources of the body, the tangible re- 
sults of which appear quite slowly. As a matter of 
fact, this effect is not noticeable from day to day, and 
is in many cases hardly discernible from week to week. 
As a rule, months, at least, must pass before genuine im- 
provement resulting from a real inward regeneration, 
manifests itself, and frequent change of residence serves 
only to interrupt this effect. 

Circumstances That May Justify a Change. Certain 
circumstances, however, may render a change of local- 
ity advisable. For example, if a test of several months 
or a year of a particular climate has brought little or 
no benefit, a change may be sought, if the patient is in 
condition to be moved. Likewise, it sometimes comes 
about that the patient improves up to a certain point, 
but fails to make further headway. In this event, the 
climate may, or may not, play a part in the matter. 
None the less, a change of climate, with which a change 
of environment is necessarily associated, may add the 
straw that once more turns the scales in Nature's favor. 
Again, if the climate of a given locality is at its best 
only during part of the year, a change of residence may 
be beneficial during the less favorable season. 

A Suitable Climate Often Close at Hand 

When circumstances dictate a change of climate, in 
order to minimize the chance of harm resulting from the 
journey, the trip should be made as short as practicable. 
Fortunately, remarkable climatic differences often exist 
in localities separated only by short distances (this is 
particularly true in the western states) a fact which 
frequently makes it possible for one to find a suitable 
climate close at hand. 



THE TRUTH ABOUT CLIMATE 333 

A Warning Against the Wanderlust 

Closely linked with the subject of climate, there is 
one insidious and injurious influence which it is neces- 
sary for the health seeker to guard against. In nearly 
every part of the land he will meet persons who will 
tell him in a manner that carries conviction — in words 
which seem to be anchored in the knowledge that comes 
only from large experience, but which are in fact usually 
based merely upon a single case or at most a few cases — 
that by all means he should go at once to such and such 
a place. The friend will very likely say that in the lo- 
cality or climate of which he speaks, certain of his 
friends made remarkable recoveries, or that he himself 
was granted a new lease of life through residing for a 
time in this or that favored spot. Hence he feels sure 
that like benefits await all sufferers who will accept 
them. The climates recommended by these well-meaning 
advisers differ from one another almost as much as black 
does from white, and are not rarely the direct opposite 
of that which the particular patient needs. More- 
over, if the circumstances of the case or cases cited be 
carefully analyzed, it will often be found that climate 
had little or nothing to do with the improvement or 
recoveries which occurred. 

Nevertheless, these more or less glowing claims may 
so tempt the invalid that he finally consents to make 
what may be an expensive and exhausting journey to the 
place recommended. On arriving at the new locality, 
his hopes — which have been already perhaps partially 
buoyed up by a pleasant anticipation of returning 
health — are ofttimes lifted still higher by the appealing 
freshness of the new surroundings. He feels quite 
cheered, and in turn braced and strengthened. In his 
enthusiasm he says to himself, "I have found the spot — 



334 LESSONS ON TUBERCULOSIS 

this is just the place for me." For a while he feels 
that he is making a rapid improvement; then as the 
newness wears off, the glamour fades, and doubt of re- 
covery begins to creep upon him. While in this gloomy 
mood, especially if the early feeling of rejuvenation has 
caused him to over-tax himself so that his strength has 
now begun to fail, he discovers that he has not yet 
found the Land of Promise, which he still believes 
awaits him somewhere. 

About this time he may come across another friend 
who, like the first one, knows "just the right place." 
Given new enthusiasm, the health seeker again becomes 
a victim of well-meant but ill-considered advice, and 
once more sets out upon a journey. Perhaps the trip 
proves too much for him; perhaps he again yields to 
the feeling of early ecstasy and invigoration resulting 
from the change in environment, and again over-steps 
the limit of his real strength ; or perhaps, because he is 
worn out from the effects of the trip, the newness of 
the surroundings this time proves insufficient to give 
him even a temporary false strength ; or, as the case may 
be, expecting too much, he is unwilling to wait for the 
slowly appearing true benefit from the new climate — so 
once more he is disappointed. 

How often it is true that in this manner the wanderer 
continues his travels, first here and then there, all the 
time wearing down his body more and more — in the 
end to conclude that the disease is incurable; while all 
the while the prize was right at hand, had he only 
known it. 

How to Get Full Value from Climate 

A final word to the sufferer who seeks benefit from 
climate: Climate will prove a valuable and true friend 
to you, if you do not expect too much from it. Climate 



THE TRUTH ABOUT CLIMATE 335 

is not an open sesame nor a magic elixir, which alone 
will restore to you the blessing of health. Above all, 
therefore, do not waste your opportunities in con- 
tinually moving about, seeking a perfect climate — a 
will-o'-the-wisp which has no existence. Instead, after 
due reflection and deliberation, decide on the place 
that you feel is best for yourself, then settle down, 
and, endeavoring to render yourself content and 
meantime remembering that time is the great healer, 
take full advantage of all that rest and fresh air offer 
you. Later, with the return of a true and lasting 
health you will see that through this method of living 
you have obtained full value from climate, and will 
feel that you have been amply repaid for your 
patience. 



LESSON XIII 

HINTS ON NURSING AND SUGGESTIONS FOR 
THE RELIEF OF DISTRESSING SYMPTOMS 

To keep the patient comfortable and happy and fully 
at ease at all times are of course little things, but time 
and again it has been proven that, to a large extent, 
recovery from tuberculosis depends upon little things. 
If the patient is to be contented and cheerful, it is 
necessary that no effort be spared to keep him free 
from pain, and from suffering and distress of all kinds. 

How a Good Nurse May Turn the Tide 

It is obvious that one who has given years of con- 
scientious thought and study to the problem of helping 
others will in all likelihood be able to do more toward 
instilling hope and cheer into the mind of the sufferer, 
and in comforting him both mentally and physically, 
than will the invalid's mere friends or kin, no matter 
how well meant their intentions. And so it has proven : 
Again and again, I have seen patients going steadily 
downward — progressing from bad to worse; then with 
the advent of a competent and tactful, faithful and 
painstaking nurse, bringing cheer and comfort to soul 
and body — in this nurse's hands, I have seen the whole 
course of events change, so that the patient who was 
apparently foredoomed, to failure, has turned com- 
pletely about and begun the climb up-hill, thence slowly 
but surely onward to complete and permanent victory. 

It is ofttimes hard to understand just what is the 
secret of the nurse 's success : it is sometimes hard to be- 

336 



HINTS ON NURSING 337 

lieve that she is doing much at all, or, at any rate, any- 
thing new or of moment, yet she has succeeded in 
changing the whole outlook. Still, if you look closely 
you will see that her practised hand is continually min- 
istering to some need; at one time she may be reading 
to the patient; again, in the course of a conversation 
on ordinary topics, unbeknown to him, she slips in a 
fitting word or two at the proper moment, inspiring him 
with courage to continue the fight. On occasions when 
his desire for food is totally lacking, she not only places 
before him daintily garnished and appetizing dishes, 
but with persuasion or a gentle word of command, as 
occasion demands, makes certain that the food is eaten. 
Watchful always, resourceful, continually on the alert 
to detect any sign calling for some new attention, ever 
looking out for the best interests of her patient and 
ready at a moment's notice to devise some new and 
ingenious scheme for promoting his welfare: such a 
nurse is deserving of the highest commendation — and 
after her patient has been led by her through the siege 
of sickness, and has at last come again fully into his 
own, he cannot say too much in praise of her. 

With this little introduction to the properly quali- 
fied nurse, I wish to urge strongly upon those who 
are very ill that it will probably be to their inestimable 
advantage to have near them a nurse skilled in the 
care of tuberculous patients. If the finances permit, 
the accumulating dividends will repay many fold the 
relatively small investment required for this service. 

The question is frequently asked whether a "trained 
nurse' ' or a "practical nurse' * is preferable. If the 
nurse has had a thorough course of study and train- 
ing in a well conducted hospital, this is an advantage, 
provided she has had sufficient experience with tuber- 
culous oases (which some hospital graduates do not 

22 



338 LESSONS ON TUBERCULOSIS 

have). On the other hand, certain " practical nurses' * 
have had extraordinary opportunities for becoming 
adept in handling tuberculosis and with some this larger 
experience may more than make up for their lack of 
preliminary training. 

Helps for the Patients 

In no sense are the suggestions and instructions that 
appear under this heading intended to supplant the 
counsel of the reliable physician. Their purpose is 
merely to outline the first-aid treatment to be applied 
ere the physician arrives, and to indicate a rational line 
of procedure in the event that a physician is un- 
obtainable. 

FEVER 

In the first place, it should be understood that 
unless the fever is high or long continued, it does 
no great harm. It is the fire of disease in the 
lungs that is the great source of harm, and the 
fever is to be looked upon more as a disagreeable 
and distressing result, rather than the basic cause 
of the difficulty. As a matter of fact, fever is in a 
sense an indication that the cells of the body are re- 
sponding to the test of battle and are putting up a 
vigorous fight against the germ enemy. By the same 
token, the mere fact that the fever shows a tendency 
to run in waves — now low or absent, now present or 
high — by no means necessarily signifies that the lungs 
are in worse condition at the time the fever is higher. 
This statement holds true whether or not the rise in 
fever is accompanied by a change in the amount of 
cough and expectoration. If these points, which have 
been dealt with more fully in Lesson IV, are stamped 
on the mind, much needless worry and discouragement 
will be avoided. 



HINTS ON NURSING 339 

Treatment of Fever. The most effectual remedy for 
fever is absolute physical and mental rest— or as nearly 
complete rest of both mind and body as it is possible to 
secure. In other words, rest is the ideal treatment for 
active tuberculosis ; and as the fire of disease is smoth- 
ered, the fever will, as a matter of course, abate and 
finally cease. For details of the rest treatment the 
reader is referred to Lesson IX. 

Moreover, it is important that the rest program be 
carried out in the open air ; full instructions for health- 
ful outdoor living being given in Lesson XI. 

Sponging the body with cool or cold water when the 
fever is high, the precise temperature of the water being 
regulated by the requirements of each case, will often 
assist in making the fevered patient comfortable and 
contented, will aid the various bodily organs in carrying 
on their accustomed duties and, to a certain extent, will 
help in lowering the fever. (See Lesson XV for direc- 
tions for administering the cold bath.) 

If the fever is due to some incidental factor, such as 
constipation, digestive disorder, excitement, or taking 
cold, appropriate measures should be instituted. 

Diet and Drink. During fever the body has greater 
need for nourishment than at other times, but also has 
less power to digest and assimilate food. Consequently, 
let the ability of the body to handle the food be the 
chief guide, rather than be guided by the degree of fever 
present. Unless there is definite evidence that the food 
is not being cared for properly, the rules should be: 
(1) Eat generously without "stuffing"; (2) Eat 
foods that tax the digestive organs as little as possible ; 
and (3) Eat foods that count. 

Milk in some form, if necessary partially predigested 
by following the directions enclosed with tubes of pep- 
tonizing powder obtainable of any druggist, should form 



340 LESSONS ON TUBERCULOSIS 

a large part of the dietary in fever. Soft and light 
foods, such as milk toast, toast, zwieback, stale bread, 
the breakfast foods, rice, soft boiled or poached eggs, 
custard, blanc mange, tapioca and raw scraped meat 
sandwiches — all are also excellent, unless shown to dis- 
agree. These articles are mentioned mainly because 
they are ordinarily well tolerated, but in each case the 
list should be widened as much as practicable up to the 
point where the menus are quite liberal. To vary the 
menu and also because it contains much nourishment, 
ice-cream is permissible and valuable. 

Cold water should be drunk freely unless there is 
some valid reason for not drinking it. (In this connec- 
tion, see footnote in Lesson X, p. 252.) The water should 
be sipped slowly and not hastily gulped down in large 
quantities. If it agrees, a drink of lemonade or orange- 
ade, now and then, will be both cooling and refreshing. 
Stimulating drinks are ordinarily to be forbidden un- 
less prescribed by the physician for a special pur- 
pose. 

Medication. If the fever remains high despite the 
use of cold, or if it is not feasible to administer the 
cold bath, a small dose of aspirin will probably lower 
the fever temporarily, will ease the aches and pains of 
the patient, and serve to promote comfort and rest. One 
of the commercial 5-grain tablets of aspirin, followed by 
a half glass of water, is in most cases adequate ; half a 
tablet will perhaps suffice. Aspirin has some tendency 
to induce sweating and to depress slightly certain weak 
patients, so if not accustomed to taking aspirin, the first 
dose should be small. In all cases the smallest dose that 
will do the work should be taken. Finally, let each 
individual forearm himself against falling into the habit 
of dosing up with aspirin for each minor feeling of 
discomfort. Remember that this drug is not curative, 



HINTS ON NURSING 341 

but merely gives temporary relief. Temporary relief 
is of course worth a great deal, yet if aspirin be taken 
too frequently it may lose its good influence and even 
work injury. 

No other medicine for the reduction of fever should 
be taken except on the advice of a physician, 

StiEEP SWEATS 

Excessive sweating during the night or while asleep 
during the day, is a troublesome feature in a good many 
cases. A tremendous amount of poisonous waste ma- 
terial is eliminated in the perspiration, and for this 
reason it is obvious that those who are ill of tuberculosis 
will sweat more than if they were well. To a certain 
extent, then, the tendency of tuberculous persons to 
sweat more than normally signifies that Nature has 
taken steps to protect them. On the other hand, it is 
a well-known fact that Nature is often inclined to 
overdo things — to "run a good thing into the ground.' * 
For this and other reasons it sometimes happens in 
tuberculosis, especially during sleep, that the amount 
of perspiration is excessive even above the extraordinary 
requirements imposed by illness. Chilling of the body 
and the taking of a severe cold, as well as more or less 
weakness, are now and then sequels of a drenching night 
or sleep sweat. All in all, sleep and rest are interfered 
with, indirectly delaying recovery; so under these cir- 
cumstances measures for relief are in order. 

Let this be the rule : When the sweats are light, when 
rest is not materially interfered with and no other 
serious effect is noted, let them alone. When, on the 
contrary, some real and decided ill effect is produced, 
definite counteractive measures should be taken. Fortu- 
nately in most cases some simple procedure will achieve 
the desired end. 



342 LESSONS ON TUBERCULOSIS 

General Measures. First of all let it be noted that 
those who have been living in cramped, ill-ventilated 
quarters will often be pleasurably surprised, soon after 
taking up the open-air life, to discover that the excessive 
sweating has ceased. Likewise, continual rest in bed — 
which is in most cases necessary for other reasons — also 
has a most beneficial effect on the sweats. So, too, daily 
sponging of the body with cold water is exceedingly 
useful in toning up the skin, thereby serving both as a 
preventive and cure for excessive perspiration. 

Once profuse sweats have developed, gentle sponging 
of the body at some time during the day and again 
before going to sleep, with one of the following prepara- 
tions, will be helpful. 

1. Alcohol and water in equal parts. 

2. Pure alcohol. 

3. A mixture of a teaspoonful of powdered alum in 
a pint of either water or alcohol, or half and half of each. 
(To be shaken before use). 

4. Quinine in alcohol, 60 grains to the pint. 

5. A solution made by dissolving 120 grains of 
chloral hydrate in four ounces each of water and brandy. 

6. Cologne, two tablespoonfuls in a pint of water. 
Simplest and perhaps best of all is the vinegar sponge, 

composed of vinegar and water in equal parts, this 
mixture preferably applied while hot. If this fails, 
pure vinegar may be used. 

Various Suggestions. Following the outbreak of 
sweat it is essential that chilling be avoided. To forestall 
a chill, as well as to prevent the annoying clammy 
feeling, those who are inclined to sweat easily should 
wear light flannel night garments unless the weather 
is exceedingly hot. The bed covering should be as light 
as compatible with the air temperature. If the perspira- 
tion should be so drenching as to require a change of 



HINTS ON NURSING 343 

garment, all windows and openings through which a 
draft enters should be closed temporarily, and the 
change made as quickly as possible. If weakness follows 
the sweat, a cup of coffee or hot chocolate, or a little 
food, may be given. If necessary, a quarter or a half 
teaspoonful of aromatic spirits of ammonia, or an equal 
amount of Hoffmann's Anodyne, in a quarter glass of 
water, may be given to strengthen the sufferer and to 
tide him over the distressing period. 

In refractory cases medicines to directly check the 
perspiration are sometimes indicated, but they should 
not be taken save when prescribed by a physician con- 
versant with all circumstances of the case, 

CHILLS 

Definite chills are not very common in tuberculosis, 
altho moderate chilly feelings are of rather frequent 
occurrence in some cases. As regards the prevention 
of chilliness and chills the aim should be, on the one 
hand, to avoid all undue exposure, and on the other, 
to harden and toughen the body as much as possible 
by wearing reasonably light clothing, by using only a 
corresponding amount of bed covering, by securing at 
all times an abundance of fresh pure air and sunlight, 
by daily cold bathing, and the like. Keeping the lower 
limbs well protected from cold and damp, especially 
when sitting out in wintry air, though a small item, 
yet adds much to the general comfort and goes a long 
way toward warding off all chills. 

So far as measures applicable at the time of the chill 
are concerned, the only points worth noting here are 
the giving of hot drinks; fairly brisk rubbing of the 
body, especially the extremities ; the use of warm cover- 
ings; and the applying of external heat, by means of 
hot-water bags or similar devices. 



344 LESSONS ON TUBERCULOSIS 

COUGH, EXPECTORATION AND THROAT SYMPTOMS 

The Relationship of Throat Symptoms to Lung" 
Tuberculosis. Lest the invalid, whose throat gives 
him much trouble, be caused needless alarm and worry, 
from fear that his condition has been complicated by 
tuberculosis of the throat, I wish to make plain that 
all sorts of throat symptoms are common in pure, un- 
complicated tuberculosis of the lungs. Those who wish 
further information on this point should read Lesson 
V, pp. 108 and 122. 

The Importance of Voluntary Control of Cough. 
Many spells of racking, weakening cough can be averted 
entirely, or at least reduced to a negligible quantity, 
merely by making up the mind firmly not to yield to 
the impulse to cough. Even when the impulse is almost 
irresistible, it may often be conquered by the simple 
expedient of holding the breath for a moment or two. 
Of course it will not be possible to do away with cough 
entirely. But remember that for a very weak patient, 
one paroxysm of exhausting cough may more than undo 
all that has been gained otherwise in a day or longer; 
that each bit of unnecessary cough, restrained, means 
just that much energy and strength saved — just that 
much less tearing down of the tender fibers in Nature's 
lace-work of reparative tissue — just that much less work 
for her to do over. 

There need be small fear that harm will come from 
restricting the cough intentionally, for as soon as the 
sputum has liquefied sufficiently, most of it will be 
carried up into the throat involuntarily, where its 
presence is first noticed and from where it can be readily 
removed simply by clearing the throat. Only occasion- 
ally, perhaps, will a slight cough be required to lift up 
some of the sputum that is a little thicker and more 
tenacious. 



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HINTS ON NUESING 345 

How Guarded Use of the Voice Lessens Cough. Then, 
too, many wholly useless, trying spasms of cough may 
be obviated merely by exercising care in the use of the 
voice. Again and again I have seen patients throw 
away their chances needlessly, solely through failure to 
put a check on their impulses to talk loudly and laugh 
boisterously. Make it a plan to speak in moderate tones, 
not to allow yourself to become excited, nor to converse 
too long at a time. Likewise, keep your laughter within 
the bounds of moderation, especially if you notice that 
cough follows a too hilarious outbreak of mirth. If the 
slightest use of the voice provokes a seizure of cough, it 
may be advisable to speak only in whispers, or to stop 
speaking entirely and adopt some signal system, or have 
recourse to a writing pad. Singing, and any other acts 
necessitating excessively rapid or too deep breathing, 
should be forbidden. 

Posture As an Aid to Expectoration. A simple 
change of position is sometimes very helpful in clearing 
out the secretions. For example, one often learns from 
experience that resting on one side or the other, or even 
upon the stomach, makes a great difference in the ability 
to raise the discharge. Again, if one reclines with the 
head and shoulders over the edge of the bed so they 
are lower than the body, this may prove of much assist- 
ance. When this proves true, it is a good plan to assume 
the new position for a few minutes at regular times 
once or twice daily; remaining in this posture until 
with the aid of gravity the accumulated secretions have 
been removed.* As a rule, the early morning hour is 

* The more or less continual elevating" of the foot of the 
bed is the distinctive feature of the Jacobi postural treatment 
of tuberculosis. There is no doubt that in certain instances 
this procedure aids materially in keeping the breathing passages 
cleaned out. In selected cases it is probable that the influence of 
gravity in increasing the quantity of blood in the lungs, carry- 
ing material for repair, is also in this way of value in promot- 
ing healing. 



346 LESSONS ON TUBERCULOSIS 

best suited to the purpose. Once the secretions that 
have been formed during the night have been drained 
out, complete relief from cough and expectoration may- 
be had for a number of hours. 

Home Remedies and Other Suggestions. The ap- 
plication of a cold cloth or compress to the throat, or a 
cold wet jacket to the chest, overnight (according to the 
directions given in Lesson XV), will often prove very 
grateful to one who suffers frequently from rawness 
and discomfort in the throat, also affording surprizing 
relief from the perhaps associated harsh and distressing 
cough. In other instances a hot compress will be of 
more service. Rule: Apply cold or heat, according 
as one or the other best answers the purpose. 

A very trying cough may often be quieted merely by 
taking sips of ice-water or cold water, or by allowing 
a small piece of ice to melt in the mouth from time to 
time. Water with a little sugar in it, or water con- 
taining glycerin in the proportion of a tablespoonful 
to the glass; the sipping of a little orange or lemon 
juice, or of a glass of milk; gargling the throat with 
water containing a few drops of essence of peppermint ; 
and the chewing of a stick of gum — all are simple yet 
effective means for relieving the dry, parched, uncom- 
fortable feeling in the throat, for suppressing throat 
tickle and quieting cough. Again, a mild lozenge of 
some sort, such as a plain lozenge of slippery elm or of 
licorice, or a mentholated troche, answers the same pur- 
pose. A wide variety of excellent lozenges combining 
various soothing ingredients are also to be had, among 
which you are almost certain to find one furnishing 
just the right combination for your own case. 

A drink of hot water or a glass of hot milk will per- 
haps serve to ' 'loosen' ' the expectoration and make 
easier the raising of the discharge. This effect can 



HINTS ON NURSING 347 

often be promoted by stirring into the glassful of water 
a quarter teaspoonf ul of baking soda. 

The early morning cough, and to a less extent cough 
at other hours, has quite a noticeable tendency to pro- 
duce gagging, which not rarely terminates in an attack 
of vomiting. When this tendency is at all pronounced, 
it is well to postpone the eating of breakfast until per- 
haps half an hour after the morning house cleaning is 
over with. In this way the loss of the meal can usually 
be obviated. Under these circumstances, too, it is wise 
to lie down, to avoid all excitement and to rest very 
quietly for an hour after the meal. If food is vomited by 
a patient who is very weak and in urgent need of nutri- 
ment, after permitting a suitable interval to elapse for 
the stomach to settle, he should again partake of food. 

For the weakness following a prolonged spell of severe 
coughing, the holding of smelling salts (carbonate of 
ammonia) close to, but not too near, the nostrils for a 
few seconds; or the drinking, in a convenient quantity 
of water, of a quarter or half teaspoonful of either 
aromatic spirits of ammonia or Hoffmann's Anodyne, 
will usually afford prompt relief. 

Steam Inhalations. The inhalation of medicated 
steam — a mode of treatment that can easily be carried 
out at home — is often of benefit. The simplest way in 
which to take the inhalation is to put the required 
quantity of medicament in a pan of water boiling on the 
stove, or into a teakettle, then lower the head as close 
to the vessel as comfort permits, and breathe in the 
medicated vapor for twenty minutes or longer, three 
or four times daily. The effect may be increased by 
covering the head with a towel, or by making a paper 
cone, the larger end of which is placed over the spout of 
the kettle or over the vessel, while the other end is held 
over or near the nostrils. A so-called croup kettle, or 



348 LESSONS ON TUBERCULOSIS 

one of the commercial vapor inhalers, is a practical 
labor-saving device for taking the inhalations. 

Formula 1 Formula 2 

Compound tincture of Turpentine (chemically 

benzoin. One teaspoonful pure). One-half to one tea- 

to one tablespoonf ul to the spoonful to the pint of 

pint of water, water. 

Used in the proportions indicated, either of these 
household remedies, especially the first, makes a cheap 
and excellent inhalation for irritating or rasping cough 
and distressful feelings in the throat. 

Formula 3 
Creosote 
Twenty drops to the pint. 

Formula 4 Formula 5 

Oil of Scotch Fir, 30 drops Spirit of chloro- 

Oil of eucalyptus, 30 drops form 30 drops 

Creosote 10 drops Creosote 90 drops 

Menthol 10 grains Terebene 90 drops 

Compound tincture Oil of Scotch Fir. . 90 drops 

of benzoin 2 ounces Alcohol — to make 1 ounce 

One teaspoonful to the pint 20 drops to the pint. 

Formulas 3, 4, and 5 are useful in gradually reducing 
the cough and in lessening the quantity of sputum. 

Important: After using any of the moist-air in- 
halations do not go into the cold air for a least half an 
hour. If this rule is adhered to, colds, which may other- 
wise be a sequel of the treatment, will be prevented. 

Cold Inhalations are also of benefit, and may practi- 
cally be continued for a longer period at a time. A few 
drops of the medicament are dropped on a pledget of 



HINTS ON NURSING 349" 

cotton placed in the closed end of a small and short 
cone of paper or paste-board, which is then held to the 
nose or close to the nostrils, and the fumes inhaled. Or 
a ready-made inhaler, purchasable at small cost, may be 
more convenient. Pure creosote, alone, is of ttimes useful 
for cold inhaling. In case the cough is decidedly pro- 
nounced and the sputum profuse yet fever is absent, the 
breathing in of the creosote vapor may, if practicable, 
be continued for several hours at a time, or even for the 
greater part of the day, to advantage. If the expecto- 
rated matter is decidedly sticky and thick, and foul 
smelling, the likelihood is increased that creosote will 
be helpful. The inhaler or mask may be kept in place by 
a band fastened round the head, removing it from time 
to time to replenish the medicament. Used in this 
manner, creosote is not only an efficient deodorizer, but 
often accomplishes much toward reducing the amount 
of cough and discharge. 

Formulas 4 and 5 above are also useful for cold in- 
haling. 



In regard to " colds,' ' it is necessary to emphasize 
again that the little flurries occurring now and then in 
certain cases, which are usually assumed to be ordinary 
colds, are often merely the little ups and downs of the 
disease. As a rule these little characteristic fluctuations 
in the symptoms call for no special treatment, other than 
the faithful observance of the rules of living specified 
in the previous lessons. This means, of course, that if 
not already confined to bed constantly, additional rest 
should be taken at this time. If this is done, within 
a week or two the symptoms will in nearly all instances 
subside without further attention, tho occasionally 
the little flurry may be drawn out over a considerably 



350 LESSONS ON TUBERCULOSIS 

longer time. Even in this event, the continued confident 
adherence to the rest schedule will in the large majority 
of instances serve to carry one safely through the stormy 
period; whereupon, to one's surprise and gratification, 
the discovery perhaps may be made that healing has 
been going on all the time, and that one is now in 
position to regain strength and recuperate more rapidly. 

Genuine colds may, however, be contracted, but they 
too are best treated by rest in bed, by attention to the 
bowels, and the like. A mustard plaster may be applied 
to the chest, or other means of producing counter-irri- 
tation employed. If the patient is not too weak, a hot 
drink and a hot bath, to induce sweating; and a hot 
mustard foot-bath (made by mixing a tablespoonful or 
so of mustard in a pail of hot water), after which the 
patient immediately gets into bed and covers himself 
well — taken at the onset, may aid materially in throwing 
off the cold. Sweating may be encouraged by covering 
the patient with warm blankets, by placing hot-water 
bags in the bed, and by the administration of one-half 
teaspoonful of sweet spirit of niter every two hours for 
a few doses. Caution: When any measure to induce 
sweating is employed, care should be taken to avoid 
unduly exposing the body, else more cold may be taken. 

Note Regarding the Prevention of Colds. The open- 
air life and the avoidance of other persons afflicted with 
colds, are the most important measures of prevention. 
Vaccines for the prevention of colds are also of some 
value. In addition, it may be usefully remembered that 
certain persons who habitually overeat are especially 
susceptible to colds. Limiting, especially, the sugar and 
starches in the dietary, will sometimes help to overcome 
this susceptibility. In no case, however, should nutrition 
be slighted by cutting out articles of food that are really 
necessary. 



HINTS ON NURSING 351 

BLOOD SPITTING: HEMORRHAGE 

Altho some patients never bring up even the slightest 
tinge of blood from the lungs, yet on the whole the spit- 
ting of blood is a characteristic feature of tuberculosis, 
and in a smaller or larger quantity, blood is raised 
during some stage of the disease by perhaps a majority 
of patients. 

Some Common Misunderstandings Rectified. Because 
the source and mechanism of the bleeding is often not 
fully understood, with the result that inappropriate 
treatment is applied, it may prove profitable to give a few 
moments to discussing these matters, ere the measures 
for preventing and combating hemorrhage are described. 

At the start, let it be explained that any loss of blood 
is a hemorrhage. A quite general impression is abroad 
that only the coughing up of a fairly large quantity of 
blood is to be looked upon as a hemorrhage. As a 
matter of fact, the term hemorrhage means simply a 
flow of blood, or plain Heeding; hence the appearance 
of the smallest amount of blood indicates that a small 
hemorrhage has taken place somewhere. In the absence 
of definite and conclusive proof to the contrary, the only 
safe rule is to assume that the blood comes from the 
lungs, and to act accordingly. Far, far too often in the 
past it has been erroneously taken for granted that the 
source of the blood has been the gums, the throat, the 
nose, etc. The sequence has been that in the absence of 
suitable precautionary or corrective measures, many 
lives have been needlessly lost. True, the blood may 
come from any one of these less important sources, but 
unless positive and convincing evidence supporting this 
belief is forthcoming, it is folly to allow one's actions 
to be governed by such an assumption. 

Second: Let it be understood that many hemorrhages 



352 LESSONS ON TUBERCULOSIS 

cease spontaneously with no treatment or management 
whatever. Sometimes even a very profuse hemorrhage 
will stop completely without the slightest amount of 
rest, even tho absolutely no protective or antidotal 
measure is taken. Yet it is never wise to wait with 
trust and hope that the bleeding will cease of its own 
accord ; for in many cases it will not do so. 

Nevertheless, the fact that many hemorrhages are 
checked by Nature without assistance, leads to the 
question: Is it necessary to pay attention to an occa- 
sional tinge or spot of blood in the sputum ? The answer 
is : Yes. While it is true that in some cases the spitting 
of small quantities of blood or blood-streaked sputum 
is continued for weeks or months without ill-effect, yet 
there is always the chance that a serious hemorrhage 
will occur at any time. In no case, therefore, should 
even the smallest amount of blood in the sputum be 
ignored, except on the advice of a physician adept in 
treating tuberculosis. 

Third: Almost all hemorrhages, no matter how large 
or how long continued, or how often repeated, can be 
ultimately checked, if measures that give Nature half 
a chance be consistently and perseveringly applied. 

THE TREATMENT OP HEMORRHAGE 

The essential items in the treatment of hemorrhage 
are: (1) Rest, spelled with a capital R, (2) measures 
designed to allay the cough, (3) the gentle unloading of 
the bowels, (4) restriction of the diet, and (5) the 
application of cold to the chest and heart. 

1. Rest and Posture. At the first sign of bleeding, 
if up and about, lie down at once, and (remembering 
that the flow of blood is almost certain to stop if the 
simple steps above mentioned are carried out — remem- 
bering also that rest is the most important item of all, 



HINTS ON NURSING 353 

and that a definite and decided turn for the better 
sometimes dates from a hemorrhage*) — calm yourself 
as much as possible, and rest at ease, meanwhile shifting 
the bodily position, especially the chest and arms, little 
if at all. 

Both mental and physical quietude are important. 
One of the chief aims of treatment is to reduce the 
pressure of the onward-coursing blood against the vessel 
wall at the site of the bleeding. To obtain this object, 
it is important to secure as nearly as possible absolute 
rest and relaxation of mind and body. 

The recumbent position is proper, although the semi- 
sitting posture is sometimes an advantage. Pillows or a 
back rest may be utilized in raising the head, shoulders 
and chest, but whatever form of support is used, the 
muscles must be under no strain and the patient must 
not support himself at all. Elevating the head of the 
bed accomplishes the same end — the aim being to procure 
the aid of gravitation in lessening the quantity of blood 
in the lungs. If, however, the hemorrhage is so large 
that the blood floods the bronchial tubes so continuously 
that there is pronounced difficulty in breathing, it may, 



* This is in some cases accounted for by the more complete 
rest taken as a result of the hemorrhage. In part, too, there 
is at times a direct connection between the cause of bleeding and 
the stimulation of repair and healing. Everyone knows that 
the slightest irritation or scratching is liable to cause an ooz- 
ing of blood from an actively healing sore or cut on the surface 
of the body. This is because Nature has constructed in the 
neighborhood a network of new blood vessels to carry a 
larger supply of reparative material to hasten the union of the 
edges of the cut. For the same reason, Nature endeavors to 
send an increased supply of blood to the tuberculous lung. It 
can readily be seen then, how a spell of coughing, unusual ex- 
citement or exertion may increase the force of this circulating 
fluid sufficiently to cause the rupture of one or more of the 
delicate, newly formed blood vessels. Again, if at any time 
previously the wall of a large vessel has been weakened, how 
the combination of these factors may cause the thin spot in the 
wall to give way. This explanation could be extended, but what- 
ever the exact connection between the two events, it is often true 
that in the train of the hemorrhage there comes a definite change 
for the better. However, as it is in no case possible to predict 
in advance that the end-result will be thus favorable and happy, 
all means for checking the bleeding should be used in every in- 
stance. 
23 



354 LESSONS ON TUBERCULOSIS 

on the contrary, prove beneficial to raise the foot of the 
bed. In this case, gravity is turned to account in the 
opposite direction and for a different purpose. The 
lowering of the head not only helps to empty the bron- 
chial tubes of blood, making breathing easier, but causes 
a brisk flow of blood to the brain to sustain the vital 
centers during the period of weakness which often is a 
sequel of a large hemorrhage. In this manner a fainting 
spell can usually be averted. 

If it is known with reasonable certainty from which 
lung the hemorrhage comes, it will perhaps be helpful 
to lie on that side, provided the breathing is not ma- 
terially impeded by so doing. 

When spitting out the blood, a shallow receptacle 
should be used, so that it will be unnecessary to raise 
the head. If the patient is reclining on his back, the 
head may be kept turned to one side, or may be turned 
aside when necessary ; then with the edge of the receiving 
vessel held against the cheek, the blood should be 
expectorated with as little effort as possible. 

Only those in attendance on the patient should remain 
in the room. 

2. Restriction of Cough. Every voluntary effort 
should be made to restrain the cough, unless coughing 
is absolutely necessary for removing the rapidly accu- 
mulating blood, to allow free breathing. Breathing will 
almost never be seriously interfered with except in very 
large hemorrhages. In all other cases every bit of cough 
should be checked by force of will, if possible, no matter 
how hard it is to resist the temptation. On no account 
try to force out the clotted blood. Bear in mind that it 
is necessary for the clot to harden and set, in order 
to effectually seal the hole in the bleeding vessel. Cough- 
ing up the clots will but multiply Nature's labors in 
this direction. No talking should be permitted unless 



HINTS ON NURSING 355 

absolutely unavoidable ; even then one should speak only 
in the lowest tone or whisper. 

If medicine to allay cough has previously been pre- 
scribed by a physician, the customary dose of this 
medicine should be administered, provided a dose has 
not been taken just shortly before, or unless there is 
some sound reason for not giving it at this time. 

Important: At time of hemorrhage it is impor- 
tant to avoid gagging or vomiting, so when administering 
any medicine inclined to irritate the stomach, careful 
estimate should be made of whether the remedy has 
sufficient value to warrant this risk. For the assistance 
of the physician it is advisable to make careful note of 
the medicine administered. 

3. Attention to the Bowels. Unless the bowels 
have moved freely just previous to the hemorrhage, a 
satisfactory evacuation should be secured in the least 
disturbing manner as soon as practicable ; thereafter, one 
or more daily movements should be obtained by suitable 
means. In some cases an enema (rectal injection) of 
warm salt water will best serve the need. Other in- 
gredients, such as those mentioned at the end of this 
lesson, may be added to the injection fluid if required. 
Ordinarily, however, a good dose of salts, or some other 
form of saline,* repeated as necessary to keep the bowels 
moving more freely than normal, will be better than 
an enema. 

Note: The effervescent salines, such as the citrate 
of magnesia and the Seidlitz powder, create undesirable 
pressure in the stomach at this time, yet if ordinary 

* All saline preparations have a doubly valuable effect in time 
of hemorrhage. (1) They serve to clear the bowels quickly, thus 
rapidly removing poisonous material that if retained would tend 
to raise the blood pressure. (2) Salines abstract water from 
the tissues of the body, and it is this water, pouring into the 
intestines, which produces a thorough flushing of the bowels. In 
turn the removal of fluid from the tissues and blood, brings 
about a decrease in the total volume of blood in circulation, thus 
assisting in another manner in reducing the blood pressure. 



356 LESSONS ON TUBERCULOSIS 

salts has a tendency to produce vomiting in the given 
case, an effervescent preparation may be preferable. 

If some other laxative or cathartic seems more appro- 
priate it may be given, provided the object — the secur- 
ing of free and loose evacuations at rather frequent 
intervals, without, however, being so frequent as to 
weaken the patient excessively— is attained. 

The patient should not get up to go to the toilet, but 
should use a bedpan and urinal. 

4. Pood and Drink. The administration of nourish- 
ment should be stopped at once and not resumed for at 
least a number of hours. Fluid should be held to the 
minimum. Small pieces of ice allowed to melt in the 
mouth from time to time will serve both to allay thirst 
and to reduce cough. Whatever liquids are taken should 
preferably be drawn through a glass tube, a piece of 
rubber tubing, or a straw, in order to avoid raising the 
head. Likewise, friendly aid in feeding the invalid 
will be worth a great deal. The first nourishment should 
consist of only a very small quantity, and for a long 
period the food should be simple, easily digested, and 
light or soft, so as to require but little chewing. No hot 
or stimulating food or drink should be taken. Milk, 
buttermilk, cottage cheese, junket, blanc mange, tapioca, 
boiled rice, toast moistened with milk or water, the softer 
breakfast foods, and soft boiled or poached eggs, are 
among the permissible articles. 

An article that serves to satisfy the craving for food 
without harmful effect, and which is thought to have 
some special value in checking the bleeding, but which 
is worth little as a food, is gelatin. On the whole, 
preparations of gelatin may be given a rather frequent 
place on the menu at these times. 

5. Cold Applications. When it can be judged with 
reasonable accuracy from which lung and from what 



HINTS ON NURSING 357 

part of the lung the hemorrhage is occurring, an ice- 
bag should be placed over that area, and the supply of 
ice replenished from time to time. If the skin becomes 
blue, remove the ice-bag until the skin has again taken 
on its natural color. In an emergency, a small flat piece 
of ice or a number of chips wrapped in a piece of oil 
cloth or other covering, will make a satisfactory substi- 
tute. If the heart-beat is very rapid or tumultuous, an 
ice-bag or cold applications placed over the heart will 
help in quieting it. 

Note: It is important not to run to extremes in 
the use of cold. Care should be used to avoid chilling 
the patient, else more harm than good may be done. 

How Long Should Rest Be Continued After a Hem- 
orrhage? During the first twenty-four hours, at least, 
it is safest to rest constantly in the same position in bed, 
if the loss of blood amounts to more than a teaspoonful 
or two. Even if the quantity is smaller than this, the 
patient should remain in bed, but it is not essential that 
he lie constantly in one attitude. At the end of this 
period, or later, as seems best, if all goes well the 
invalid may be cautiously turned and given a chance 
for gaining comfort. For some days, however, moving 
about in the bed should be curtailed to a reasonable 
minimum, and the services of friendly, assisting hands 
availed of each time that the position is shifted ever 
so little. 

In the event of the bleeding continuing for several 
days or more at a time, the period of absolute rest 
should also be prolonged, and all precautions redoubled. 
If more than a teaspoonful of blood has been expecto- 
rated, it will be wise as a rule for the patient to remain 
in bed for at least ten days after all trace of color has 
disappeared from the sputum. Previous to this, how- 
ever, provided there are no other reasons in the particu- 



358 LESSONS ON TUBERCULOSIS 

lar case for enforcing continued rest, he may be per- 
mitted to sit up in bed for at first a very brief, then a 
longer time, each day. 

When allowed to get out of bed, walking is not to be 
undertaken for some time. First, it is necessary to go 
through the step-like process of sitting in a chair, a 
little longer each day; by and by adding a few steps 
around the room to the allowance. So on, day by day, 
degree by degree, the convalescent progressively gets 
about more and more. For a long time, all moving 
about should be done with extraordinary care and 
watchfulness, and all movements that entail deep breath- 
ing should be especially avoided. 

Exception: Now and then instances of hemorrhage 
occur wherein the bleeding is more in the nature of a 
passive oozing at occasional intervals, rather than an 
active streaming of the blood — the so-called " congestive' ' 
hemorrhage. In the management of a congestive hemor- 
rhage one may be permitted a few more liberties ; thus, 
for example, from the beginning one may be allowed to 
sit up a short time each day or even to move slowly 
about the room a little. Very limited movements of this 
sort may even have a beneficial influence. Remember, 
however, that the spitting of sputum which is merely 
blood-streaked is also very often the forerunner of a 
serious hemorrhage, and that the most expert physician 
sometimes has difficulty in deciding the exact type of the 
bleeding. Hence, those who are dependent wholly upon 
their own judgment will do well, in all instances, to 
base their actions on the assumption that the bleeding 
is not "congestive," and to carry out faithfully the 
rest regimen. 

The Pneumothorax Treatment of Hemorrhage. In 
recent years a practical method of causing collapse of 
the lung, relieving it of its accustomed work and giving 



HINTS ON NURSING 359 

it opportunity for rest and repair, has been developed. 
This procedure, called induced or artificial pneumo- 
thorax, is fully described in Lesson XV. Here, it 
appears desirable merely to call attention to the fact 
that this method of treatment will sometimes check 
hemorrhage and save life after all other means of control 
have failed. 

Recurrent Hemorrhages — A Note of Cheer. Now 
and then a case occurs in which one series of hemorrhages 
follows on top of another, day after day, week after 
week, and occasionally — month after month. Under 
such circumstances the sick person is likely to feel 
greatly disheartened, and finally to become convinced 
that the bleeding will never be permanently checked. 
None the less, even in such cases, there is a way out. 
That one may understand how the offending vessel is at 
last conquered, it may be helpful to explain why, in such 
cases, the bleeding is not checked immediately. 

For example, let a concrete case be taken. Suppose a 
hemorrhage, or a series of hemorrhages, has just 
occurred. As a result of the loss of blood the total 
quantity of the circulating blood decreases, and in turn 
the blood pressure (the force exerted by the onsweeping 
blood against the inside of the blood channel) is lessened. 
Thus opportunity is given for the formation of a firm 
clot at the point of rupture, and sooner or later the 
bleeding ceases. Time passes, and, as the individual 
recuperates, his blood is enriched and augmented in 
amount, and the blood pressure again raised. This 
elevation of the blood pressure alone may be sufficient 
to renew the bleeding ; if at this time the invalid should 
suddenly and forcibly exert himself, or if he should have 
a spell of violent coughing or become unduly excited, 
another hemorrhage is even more likely to supervene. 
Should a second hemorrhage, or a series of hemorrhages, 



360 LESSONS ON TUBERCULOSIS 

actually take place, the blood pressure again falls, and 
the flow of blood is once more checked. Then comes 
another interval of convalescence, during which the 
individual builds up and perhaps gains in flesh, while 
coincidentally the number of his blood corpuscles be- 
comes greater and greater and his blood pressure higher 
and higher. Now, again, especially if he is not careful, 
the bleeding may start anew a third time. 

In this manner the vicious circle of events may con- 
tinue indefinitely, leading to great discouragement and 
causing the sufferer to feel that he is indeed " between 
the devil and the deep sea." He notices, perhaps, that 
the eating of food, which he urgently needs to furnish 
him with more energy for the fight, does harm by 
adding to the elevation of blood pressure, thus indirectly 
increasing his difficulties. 

For a time the pathway to health may indeed appear 
dark, and a stout heart may be required to continue. 
There is one fact, however, to which one may hold fast 
at all times. When every ray of light is blotted out, 
remember that any day the clouds may be wafted away, 
revealing the sunlight of health, perhaps even brighter 
and closer at hand than before. With patience and per- 
sistence, it is probable that sooner or later a firm clot 
will form and effectually seal the opening in the vessel. 
In other instances, Nature will increase the thickness 
of the vessel wall, till finally the channel is obliterated ; 
or, again, the shrinking of the new-formed healing 
tissue (scar) will squeeze firmly upon the offending 
vessel, shutting it off and effectually preventing further 
bleeding. Remember that a will to continue the fight, 
to grit the teeth and keep on when all seems lost, has 
again and again turned defeat into victory. Remember 
that many others have passed through just such periods 
of doubt and gloom, of lost faith and waning hope— only 



HINTS ON NURSING 361 

in the end to discover, to their great joy and surprize, 
that their lungs had been healing all the time — to find the 
goal just that much nearer. Bear in mind, too, that the 
ultimate results in even severe hemorrhage cases are 
on the average excellent. 

How to Guard Against Future Hemorrhages. 
Women who at any time have had hemorrhages may 
providently remain in bed during the menstrual period 
— a time during which the liability to hemorrhage is 
somewhat increased. So too, bearing in mind that con- 
stipation often precedes a hemorrhage, pains should 
be taken at all times to keep the bowels in as nearly 
normal condition as possible. If at any time a tinge of 
blood appears in the sputum, make it a plan to go to 
bed for at least a day, or at any rate remain in the 
room. 

PLEURISY 

Probably a majority of patients have at least a 
" touch" of pleurisy at one time or another; and as the 
condition is usually more or less painful, it is quite 
natural to take for granted that one has had a serious 
setback. Yet, in many instances, pleurisy is known 
to be a step toward healing. For example, it has been 
quite often observed that convalescence and recuperation 
have proceeded more rapidly after an attack of pleurisy. 
Do not, therefore, take these flare-ups of pleurisy too 
much to heart, but remember the likelihood is large 
that even without treatment the pleurisy will cease in 
time (usually within a week or two) and that it is not 
unlikely that improvement will take place more rapidly 
thereafter. 

Still, as pleurisy is usually more or less painful (the 
acute attack being in most instances brought to the 
attention of the sufferer by a knife-like stab-in-the-side, 



362 LESSONS ON TUBERCULOSIS 

causing him to catch his breath) — and as an increase 
in the cough and a rise in the fever are often associated, 
counteractive measures are called for. The chief of 
these will now be briefly described: 

1. If the patient is up, and if the pain is severe, 
or if fever is present, he should go to bed and remain 
there till the symptoms have subsided entirely, or at 
least moderated greatly. Rest is probably the best 
treatment under any circumstances. 

2. Secure an ample evacuation of the bowels by 
suitable means. 

3. Eat only such food as is readily digested. The 
hints on diet and drink given under the topic "Fever" 
earlier in this lesson will serve as a guide. 

4. One or more coats of iodin may be painted over 
the painful area every day or two, regulating the fre- 
quency of the applications by the relative sensitiveness 
of the skin. As a result of the application, a feeling 
of moderate warmth or burning is to be expected and 
desired, but blistering is to be avoided. As an alternative 
procedure, a mustard plaster (directions for the prepa- 
ration and use of which will be found near the end of 
this lesson) or some other form of application capable 
of inducing moderate counter-irritation, may be em- 
ployed. 

5. An ice-bag or cold compress may give relief, but 
as a rule a hot- water bag or heating pad is more efficient. 
Rule: Apply heat or cold, according as one or the 
other proves more useful in easing the pain. If heat 
proves more grateful, and if a daily cold sponge bath 
has previously been taken, it will probably be best 
to omit the cold baths temporarily. It may be worth 
while remembering that a drop-light equipped with a 
funnel-shaped reflector, which may be easily slipt 
under the bed covers, makes a very good substitute for 
an electric heating pad. 



HINTS ON NURSING 363 

6. Fixation of the affected side with strips of adhesive 
plaster, for the purpose of limiting the depth of the 
breathing, is one of the most effective means of checking 
the pain and cutting short the attack. The decision as 
to whether or not it is wise to limit the motion of the 
side in this manner, as well as the actual application of 
the plaster, of course falls within the province of the 
physician. 

For relieving the pain of pleurisy, when mild, one or 
two 5-grain tablets of aspirin, followed by a half glass 
of water, may be taken every two to four hours for a 
few doses, or, if no untoward effect is noted, the tablets 
may be taken over a longer period. Important: 
Remember that aspirin has no direct curative action 
and is somewhat depressing to the heart and circulation. 
It also has a tendency to cause sweating. If the patient 
is weak, aspirin should be given very cautiously, and 
in any case if weakness seems to be induced or exagger- 
ated, the dose should be reduced, the interval lengthened, 
or the use of aspirin abandoned. 

Medicine for the relief of severe pleural pain, as well 
as other treatment, must be left to the judgment of the 
physician. 

11 Water on the Chest:" Pleural Effusion. In some 
cases of pleurisy, fluid accumulates in the space between 
the lung and the chest wall (pleural effusion). By 
compressing the tuberculous lung, easing its labors and 
promoting rest, this fluid often serves as an aid to 
recovery. On the other hand, the accumulation of 
liquid sometimes grows so large as to seriously interfere 
with breathing, or does harm in other ways. In this case 
the partial or complete withdrawal of the fluid by means 
of a hollow needle inserted through the chest wall 
(tapping) may be demanded. In some cases it is 
necessary to "tap" several or many times. 



364 LESSONS ON TUBERCULOSIS 

ACHES AND PAINS 

Aches and pains and sore spots over the chest, usually 
of a mild or moderate nature, are rather characteristic 
of tuberculosis, altho they do not occur in all cases. 
No doubt many of these indefinite pains and aches are 
due to mild pleurisy ; or to the effect of weather changes 
and the like in causing a congestion of old scars in the 
lungs and of pleuritic thickenings and adhesions.* 

In some cases the pain continues or recurs persistently 
in one place ; but in others it is of a wandering character 
— one time in one part of the chest, the next in a totally 
different spot, and so on, continuing its migration from 
place to place. Again, it is referred to points outside of 
the chest, most frequently to the shoulders, neck or arms. 
Such pain is apt to be due to a neuritis (nerve inflam- 
mation), initiated in the chest and extending outward 
and eventually to the nerves supplying the exterior parts 
of the anatomy just mentioned. In other instances the 
pain is merely referred outward, without actual inflam- 
mation of the nerves — sympathetic, referred or reflex 
pain. When the pain is located chiefly in the muscles, 
it is spoken of as muscular pain or myalgia; or it may 
be mistakenly ascribed to the familiar cover-all — 
rheumatism. Not rarely it is impossible to pin the pain 
to any single, definite cause — except to say that the real 
root of the trouble is the tuberculous process in the lungs. 

In any event, the main thing to remember is that in 
only a few cases does pain indicate the onset of a serious 
complication. In the great majority of cases it is with- 

* The pleura is the thin, membranous lining that covers the 
lung's, and which is reflected onto the inner surface of the chest 
wall and to a certain extent over neighboring organs within the 
chest. As a result of inflammation (pleurisy) this membrane 
sometimes becomes thickened to many times its normal thick- 
ness; again, the inflammatory process leads to the gluing to- 
gether of the two surfaces of the pleura, finally resulting in the 
formation of either thin and delicate, or thick and tough, bands 
connecting the lung to the chest wall and surrounding parts 
(pleuritic adhesions). 



HINTS ON NURSING 365 

out serious significance and, given time, will in all likeli- 
hood disappear of its own accord, tho appropriate 
treatment will often serve to check it more promptly. 
Do not, then, permit yourself to become deprest and 
discouraged merely because you begin to suffer from 
pain ; or if pain has been previously present, because it 
becomes worse for a time. Remember, too, that in 
certain instances pain becomes prominent or is noticed 
for the first time when the lungs begin to heal (as 
explained in Lesson VIII). 

Treatment of Pain. The application of a coat of 
iodin or a mustard plaster to the seat of pain often 
brings prompt relief. Or oil of wintergreen, either 
mixed with five parts of olive oil or less, or even used 
undiluted, may be applied. If distinct tender points are 
present along the course of the nerves, the application 
of firm pressure with the finger tip to the painful spot 
for three minutes by the clock, tho increasing the 
pain at the time, will afterward often give much relief. 
Gently kneading and rubbing the parts once or twice 
daily is also very valuable in some cases. A good 
j counter-irritant and pain-relieving liniment, such as 
the following, will perhaps increase the beneficial effect 
of the massage : 

Menthol 120 grains 

Tincture of belladonna % ounce 

Tincture of aconite % ounce 

Chloroform 1 ounce 

Spirit of camphor enough to make six ounces. 



a 



Internally, aspirin may be taken as described under 
Pleurisy.' ' 



366 LESSONS ON TUBERCULOSIS 

STOMACH AND BOWEL DISTURBANCES 

In Lesson IV it has been explained how and why 
disturbances of the stomach and bowels and other ab- 
dominal organs are on the whole rather common inci- 
dents in tuberculosis. Here it may be added that these 
upsets, of one sort or another, often lead to much need- 
less worry, through causing the patient to suspect that 
after all he has not tuberculosis of the lungs, and that 
he is being treated for the wrong ailment. At any rate, 
owing to the prominence of the symptoms on the part of 
the digestive organs, he is likely to feel that the lungs are 
not the chief seat of difficulty. Or again, he may become 
convinced that he has acquired some wholly separate, 
serious stomach or bowel ailment; or that tuberculosis 
of the bowels, or some other complication or new disease 
has developed. 

Now, let these fears and forebodings be set definitely 
aside. Let it be known and understood that all sorts of 
derangements of the digestive system, ranging all the 
way from indigestion, with fermentation, gas-formation, 
sourness, burning, more or less pain and even vomiting — 
to " biliousness"; from obstinate constipation to pro- 
longed and intense diarrhea — all of these disturbances 
and others, are characteristic accompaniments of tuber- 
culosis of the lungs, uncomplicated by tuberculosis else- 
where. The digestive organs of the invalid are unusually 
sensitive, and dietary indiscretions are sometimes respon- 
sible for the disturbances, yet often no provoking cause 
can be discovered. A few more fortunate patients are 
never distrest in this way, but the majority of cases are 
marked by at least one upset of the sort — often by many. 

Of course, those who have tuberculosis may fall heir 
to other ills. They are not immune to the separate and 
distinct disorders of. the stomach and intestines simply 
because they have been attacked by tuberculosis. The 



HINTS ON NURSING 367 

same as other persons, they run a chance of acquiring, 
for instance, a dilated stomach, appendicitis, inflamma- 
tion of the gall-bladder, etc., or true tuberculosis of the 
bowels may develop. What I wish to impress is that 
this is not usually the case. The physician will of 
course take all possibilities into consideration, but in 
most instances it will be found that the patient is only 
having an experience common to a large number of those 
afflicted with tuberculosis. As a rule, the disorders will 
yield to simple measures, and in most cases coincident 
with the healing of the lungs, the tendency for the 
attacks of abdominal distress to recur will grow less 
and less. 

How to Forestall Trouble. Attention to the follow- 
ing points will obviate many of these distressing dis- 
turbances : — 

1. Use care not to swallow the sputum. Note: 
There need be no fear that serious consequences will 
follow if a small quantity of sputum is inadvertently 
swallowed. As a matter of fact, it will be impossible 
to altogether avoid swallowing the sputum (as, for ex- 
ample, during sleep) ; but not the slightest trace should 
be swallowed voluntarily. Sputum is irritating to the 
mucous membranes of the stomach and bowels, and is 
apt to produce various annoying and baneful non- 
tuberculous derangements of these organs. There is also 
some chance that the habitual swallowing of this matter, 
which should be expectorated, may lead to tuberculosis 
of the bowel, though this danger is not nearly so great 
as many suppose. 

2. Clean the teeth frequently and have them kept 
in repair. Even more important, make sure that there 
are no hidden abscesses at the roots (an X-ray examina- 
tion will determine this) and that the gums are in 
healthy condition. 



368 LESSONS ON TUBERCULOSIS 

3. Let the rules and suggestions given in Lesson X 
guide you in selecting your dietary. Be especially chary 
of overeating. Eat sparingly, if at all, of foods that 
serve merely to satisfy the appetite, while contributing 
little to strength, blood and fighting efficiency. Be wary, 
lest they turn out to be only trouble-makers. Masticate 
all food thoroughly. 

General Suggestions for Relief. Once the diges- 
tive functions have been thrown out of order, if it is 
strongly suspected that certain foods are at the bottom 
of the difficulty, or if from past experience it is known 
that certain particular articles are liable to provoke 
trouble, these foods should be promptly dropt from the 
bill-of-f are, unless the need for them is great. 

A Test and a Remedy. It is worth remembering that 
(1) sagging or dropping of the abdominal organs below 
their normal positions and (2) the accumulation or 
stagnation of impure blood in the veins within the 
abdomen, are both common occurrences in tuberculosis, 
and are responsible for many diverse and troublesome 
symptoms. It is often possible, in this event, to obtain 
relief from a wide variety of stomach and bowel upsets, 
simply by applying even pressure and support to the 
abdominal wall. If that portion of the abdomen below 
the level of the navel is prominent or bulging, this is 
fair proof that the abdominal organs are no longer in 
their customary position.* 

However, sagging of the organs may exist without 
the protruding of the abdomen below the navel. The 
physician sometimes makes the following simple test to 
ascertain with reasonable accuracy whether or not benefit 
is to be expected from treatment intended to correct 
the two conditions just described: 

* It should be understood, however, that the position of the 
abdominal organs is not precisely the same in all persons. There- 
fore, in the absence of ill effects, support to the merely slightly 
protruding abdomen is not in order. When symptoms occur, on 
the other hand, the method is well worthy of trial. 



HINTS ON NURSING 369 

Test: While the patient lies on his back, with the 
foot of the bed elevated (or a pillow under the hips) to 
allow the organs to gravitate upward into a more nearly- 
normal position, a fairly wide band of suitable material 
and width is snugly applied to the lower part of the 
abdomen — mainly below the level of the navel. To make 
certain that the binder does not slip upward, strips of 
adhesive plaster are sometimes used to fasten it to the 
skin, or tapes are sewn to its lower edge and tied around 
the thighs. 

In other cases, the physician makes use of an extra 
strong adhesive plaster — known as mole-skin plaster — 
which is put on in overlapping strips which when com- 
pleted form an unusually snug and firm, though of 
course but temporary, sling for the sagging abdomen. 

If relief is obtained in either of these ways, a more 
permanent support is then secured. Whether the sup- 
port is made to order or purchased ready-made, the 
patient should be assisted in putting it on the first 
time by some person experienced in this line of work. 
The support should be so fitted that an even, moderate 
pressure is applied, chiefly below the navel, in such a 
manner that the relaxed abdomen is gently but firmly 
squeezed upon and comprest in a backward and upward 
direction, thus pressing the blood out of the overladen 
blood vessels, and indirectly lifting the organs back into 
or near their ordinary resting places. 

Incidentally, it is worth remembering that a correctly 
applied abdominal support will relieve some cases of 
asthenia or weakness, particularly if the weakness or 
faint feeling develops when one is standing. Odd as 
it may seem, relief from mental depression or "the 
blues' ■ is also sometimes obtained. 

Some Good and Bad Poods. If disorders of the 
stomach or bowels (excluding constipation) have re- 

24 



370 LESSONS ON TUBERCULOSIS 

cently occurred, or if the stomach is inclined to be sensi- 
tive, the rule should be to eat sparingly, if at all, of the 
following articles, which are apt to be — 

trouble Makers: Pork, veal; salted meats and 
fish ; canned salmon, lobster, crab, sardines ; fried foods 
in general ; coarse breads, such as graham, whole wheat* 
rye, brown; coarse breakfast foods, such as Petti John's 
and Uncle Sam; fresh and hot bread, biscuit; pastry, 
rich cakes and rich puddings; pancakes and waffles; 
coarse vegetables, such as cabbage, cauliflower, brussels 
sprouts, turnips, spinach, kale and other greens; dried 
beans, corn-on-the-cob and stewed corn (apt to produce 
much gas) ; cucumbers, radishes, raw onions, tomatoes, 
celery, fruits in general (especially raw or over-ripe 
fruits) ; melons of all varieties ; spices and condiments, 
including vinegar ; stimulating drinks, such as tea, coffee, 
and alcoholic beverages* 

The following foods are in general allowable, tho judg- 
ment must be used: 

Permissible Foods: Raw or over-done scraped 
beef; broiled, roasted or well boiled meat or fish; in 
general, beef, lamb and mutton; fresh, sweet milk, or 
milk modified along the lines suggested in Lesson X, 
p. 232; partially digested milk (prepared according to 
the directions enclosed with peptonizing powder, pro- 
curable from any druggist) ; kumyss, artificially soured 
milk, buttermilk; junket, cottage cheese, custard, blanc 
mange; poached and soft boiled eggs (in moderation) ; 
stale bread, toast, zwieback; plain cake, if not rich; 
prepared invalid foods, such as Dennos', Eskay's, 
Nestle 's and Mellin's Food; gruels and light breakfast 
foods; Cream of Wheat, puffed or flaked wheat, rice or 
corn ; rice, farina, sago, tapioca ; baked or mashed potato, 
squash, peas, carrots, eggplant, beets, stewed onions; 
prunes, and baked and scraped apples. 



HINTS ON NURSING 371 



NAUSEA AND VOMITING 



1. Dietary Restrictions. For an acute attack the 
most important thing is to give the stomach rest and 
an opportunity for recuperation, by reducing the food 
intake. If the attack is severe, all food should be stopt 
temporarily, for one or more meals as may be necessary. 
The first food partaken of should be light and easily 
digested, or pre-digested. (See list of permissible articles 
above.) 

If the vomiting recurs frequently, a careful investi- 
gation should be made to determine whether or not some 
offending article or articles cannot be found and 
eliminated. 

Except as noted below in regard to salt water, fluids 
should be restricted. Very hot or very cold water is 
usually best tolerated. Sips of ice water or the sucking 
of small pieces of ice will both relieve thirst and help 
to soothe the sensitive mucous membrane of the stomach. 

In some cases it is helpful to take the meals entirely 
dry, and to take the fluids, in minimum quantity, an 
hour before eating. 

2. Rest of the Body. If up and around, lie down, 
and if the vomiting is severe or repeated, remain in 
bed a day or longer. 

3. Attention to the Bowels. Often constipation is 
the underlying cause of the stomach distress. When this 
explanation seems plausible, or even tho it does not, a 
dose of salts or other saline, or a warm rectal injection, 
to empty the bowels, will likely go far toward clearing 
up the difficulty. 

4. Salt Water for Washing Out the Stomach. 
Drinking a glass or two of luke-warm salt water is useful 
in washing out the stomach and in cutting short the 
attack. The salt water will either be vomited or will 



372 LESSONS ON TUBERCULOSIS 

pass on into the bowel, in either event aiding materially 
in clearing out the irritating food and secretions. Then, 
too, vomiting is less painful if there is a fair quantity of 
liquid in the stomach, than when the organ is almost 
empty. (If it is desired to empty the stomach at once 
after taking the salt water, vomiting can usually be 
induced by tickling the throat with the finger.) 

5. A Mustard Plaster placed over the pit of the 
stomach (in the angle just beneath the ribs), is an 
effective measure of relief. 

"biliousness" 

The term " biliousness' ' covers a multitude of sins, 
and has a different meaning for different persons. As 
applied here, biliousness refers to that form of stomach 
and bowel upset characterized by constipation, nausea 
and perhaps vomiting, a coated tongue, a general heavy 
or logy feeling, a full feeling in the head, and perhaps 
headache. 

Treatment. The securing of a free movement of the 
bowels by suitable means; the omitting of the meals 
until the bowels are thoroughly unloaded; and keeping 
to a light diet for a day or so thereafter, is usually all 
that is necessary. Castor oil, in the dose of one or two 
ounces, is a very effectual remedy for clearing out the 
bowels ; altho for certain cases, salts or some other form 
of saline; or, if the constipation is very pronounced and 
the patient fairly robust, one or two compound cathartic 
pills may be better. If necessary, a rectal injection 
may be used to assist in cleansing the bowel. 



HINTS ON NURSING 373 

LOSS OF APPETITE 

When the appetite fails, the relish for food may often 
be regained if care is used to avoid monotony in the 
menus, and in tastefully preparing and attractively 
garnishing the food. Here is one place where a good 
nurse proves her worth. By artfully coaxing or com- 
manding the invalid to eat, by personally feeding him, 
by preparing tempting dishes, and by adding an occa- 
sional appetite invigorator to the bill-of-fare, as well as 
in divers other ways — she will often turn the scale from 
failure to success. 

If the stomach is in condition to tolerate these articles, 
the inclusion, now and then, of one or more of the 
common appetite invigorators (such as those mentioned 
in Lesson X) in the bill-of-fare, may stimulate the 
appetite just enough to create a call for articles of 
greater food value, which may then be eaten and en- 
joyed. Caution: Remember, however, that as a class 
the appetite invigorators are rather hard on the diges- 
tion, and, on the whole, have but small food value. 

SOUR STOMACH — BURNING SENSATIONS — HEARTBURN 

These symptoms result from the presence in the 
stomach of (1) an excessive quantity of the normal acid 
(hydrochloric acid, or, as it is sometimes called, muriatic 
acid), or (2) from abnormal acids, formed as the result 
of food fermentation. Relief in both cases is afforded 
by the taking of some alkali to neutralize the acid. For 
this purpose a teaspoonful of baking soda, stirred into 
a glass of water ; a teaspoonful of light magnesia ; half 
to one tablespoonful of milk of magnesia; or one tea- 
spoonful of aromatic spirit of ammonia, well diluted 
with water should be taken at the height of the attack, 
and if necessary, repeated in two hours. The milk of 



374 LESSONS ON TUBERCULOSIS 

magnesia is laxative and, as constipation is often associ- 
ated with sour stomach, seemingly in part at least, as a 
cause, magnesia answers both needs. But if a laxative 
is not wanted, the magnesia in this form should not 
be taken. Charcoal, in the dose of five to ten grains, is 
also often of much value. 

For merely a temporary attack of acidity, probably 
no further treatment will be required. 

When the condition is long drawn out, however, further 
measures may be called for, and it should be remembered 
that the curative treatment of the two varieties of exces- 
sive acidity are rather opposite. (1) When abnormal 
acids are responsible, remedies for the purpose of aiding 
digestion, such as pepsin or hydrochloric acid, are often 
prescribed by the physician. Preparations of this kind 
assist Nature in digesting the food promptly, ere it 
stagnates and undergoes fermentation with the forma- 
tion of abnormal acids. (2) If an excess of the normal 
hydrochloric acid is responsible, the taking of anything 
that increases the acid will, of course, make the con- 
dition worse. As it is impossible to tell accurately 
from the symptoms alone which acid is responsible, in 
obstinate cases it is often necessary for the physician to 
have the patient eat one or more special or test meals, 
to be followed after a fixt interval by the withdrawal 
and examination of the food. 

1. Diet When Abnormal Acids Are Responsible. 
The food should be light and easily digested (see list of 
" Permissible Foods" on an earlier page), but no special 
dietary can be laid down, because quite different articles 
are prone to undergo fermentation in different stomachs. 
Experience is the best teacher in this regard. 

2. Diet When the Cause Is an Excess of the Normal 
Acid. The food should be mild and non-irritating. 
Stimulating food and drink, including condiments, 



HINTS ON NURSING 375 

vinegar, acid fruits, pickles, salt, and alcohol, are to be 
especially avoided. Starch is to be eaten sparingly, and 
only in the most easily digested forms, such as stale 
bread, toast, zwieback, boiled rice, and puffed or flaked 
rice, wheat or corn, Cream of Wheat, blanc mange, etc. 
Milk, eggs and meat, and fats and oils such as butter, 
cream, olive oil, etc., are usually well borne. Moreover, 
fats and oils sometimes seem to be of direct benefit in 
lessening the acidity. 

In some cases, the diet can be restricted to meat almost 
alone, to advantage. (Lean meat, which contains a 
large per cent of protein, requires a large amount of 
hydrochloric acid for its digestion, and so has a tendency 
to use up the excessive amount of acid.) It is preferable 
to eat the meat raw, or at most, cooked only a little. A 
suitable quantity of minced or grated beef, spread on 
stale bread, may be taken every three hours. 

On the other hand, the very presence of meat in the 
stomach sometimes seems to induce an even greater 
secretion of acid than is used up in the digestive process, 
and so tends to aggravate the condition. Under this 
circumstance, the alternative plan may be tried of 
omitting meat entirely, and confining the dietary to 
milk, an occasional egg or custard, the milder breadstuffs 
and cereals above indicated, and the fats and oils. 

GAS ON THE STOMACH OR BOWELS, WITH OB WITHOUT PAIN 

Here again, the regulation of the diet is the first thing 
to consider. All articles prone to produce gas in the 
individual case should be eliminated, unless they are 
vitally necessary. The following are to be especially 
avoided: Pastries and rich cakes; fried articles; hot 
baked breads; potatoes (baked potato is ordinarily the 
least harmful) ; coarse cereals, vegetables and breads ; 
dried beans of all varieties. In general, the foods listed 



376 LESSONS ON TUBERCULOSIS 

as " Trouble Makers" on a previous page are to be eaten 
sparingly. 

A hot compress applied over the stomach or bowels 
(according to the location of the trouble), for one or two 
hours, twice daily, is often a great source of comfort. 
A hot turpentine stupe may be even more effectual. 

Caution: If there is known to be trouble with the 
kidneys, turpentine should be used very guardedly. When 
making hot applications of any sort during cold weather, 
care should be used to avoid exposing the abdomen 
unduly. It is even more important that this precaution 
should be taken when removing or reapplying the source 
of heat. It should be remembered that as a result of the 
artificial warmth, the superficial blood vessels become 
dilated and engorged with blood, and if a sharp draft of 
cold air is allowed to strike the abdomen, the blood will 
be suddenly driven inward, and a new attack may per- 
haps be precipitated. 

When the trouble is chiefly in the bowels, a simple 
rectal injection of warm salt water or soapsuds, an 
asafetida enema, or a compound enema (each of which 
is described near the end of this lesson), is often the 
quickest and best way to obtain relief. In other in- 
stances, especially when the gas has accumulated low 
down in the bowel, the insertion of a well-greased rubber 
rectal tube as high as possible, which is then retained 
for some time, will greatly facilitate the expulsion of 
the gas. 

Medication. When the gas is mainly in the stomach, 
one-fourth to a teaspoonful of Hoffmann's Anodyne, 
preferably in cold water, repeated if necessary once 
or twice at intervals of twenty minutes or half an hour ; 
essence of peppermint, 10 to 30 drops, preferably in hot 
water; spirit of camphor, 10 to 30 drops, mixed with 
a little sugar, then with water — are home remedies of 



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HINTS ON NURSING 377 

much service. The Hoffmann's Anodyne is especially 
useful when pain accompanies the gas formation. A 
combination of equal parts of Hoffmann's Anodyne, 
aromatic spirit of ammonia, and essence of peppermint — 
of which one-half a teaspoonful is to be taken in water, 
is also very efficacious. 

For gas on the bowels, five drops of chemically pure 
turpentine on a lump of sugar,* or a three or five grain 
pill of asaf etida, may be taken three times daily. 

DIARRHEA 

For an acute attack, the first thing is to omit all food 
(for one or more meals, at least — perhaps for twenty- 
four hours) and, if up and about, to go to bed. If the 
attack has followed the eating of indigestible food, a 
good dose of castor oil should be taken, provided 
thorough purging has not already occurred. The pri- 
mary effect of castor oil is to sweep out the fermenting, 
irritating material ; whereas secondarily, it has a consti- 
pating action; so that altogether the effect is doubly 
valuable. Note: If the patient is already weakened 
from excessive bowel action, the castor oil should not 
be given. To assist in cleansing the bowel, a warm saline 
enema, administered very slowly, may be of material 
help. 

The first food eaten should be soft, soothing and easily 
digested (see articles listed below under chronic 
diarrhea), and the return to solid food later made 
gradually. 

If the diarrhea is prolonged or chronic, the careful 
selection of the dietary along the following lines will 
often prove curative in the end : — 

All spicy and highly seasoned food should be shunned. 
Tomatoes, cucumbers, radishes, raw onions ; coarse foods, 

* When there is known to be serious trouble with the kid- 
neys, it is usually inadvisable to administer the turpentine. 



378 LESSONS ON TUBERCULOSIS 

such as dried beans of all varieties, cabbage, cauliflower, 
spinach, kale, celery, and coarse breads ; fried foods and 
pastries — should be banned. Fruit, melons, and pork, 
should be eaten sparingly, if at all. 

Permissible foods include : stale bread, toast, zwieback ; 
boiled milk, condensed milk mixed with water, artificial 
buttermilk, peptonized or partially predigested milk 
(prepared by the use of peptonizing powder, procurable 
of all druggists), chocolate; flour and milk porridge; 
milk breakfast foods, such as Cream of Wheat, puffed 
or flaked wheat or rice or corn; boiled rice; custard, 
blanc mange ; poached egg ; scraped raw beef, overdone 
beef; beef juice (not extract of beef). As convalescence 
proceeds, soups, noodles, macaroni, spaghetti, and baked 
or mashed potatoes, may be added. 

If the diarrhea is intense an effectual mode of treat- 
ment is to omit for a few days all food except milk, 
gruel and zwieback, given every three hours in such 
quantities as seem to be indicated. Boiled milk, diluted 
condensed milk, soured milk, or partially digested milk 
may in some cases be substituted for the sweet milk. 

Daily cleansing of the lower bowel with a saline 
enema, or an enema of starch water, is another useful 
measure. 

A small dose of castor oil (say, a teaspoonful) once 
daily, over a period of time, for its constipating effect, 
is often efficacious. 

If diarrhea, cramps or abdominal pain have a tendency 
to recur frequently, it is important to protect the 
body against chilling. By keeping the cool air from 
striking the sensitive skin of the abdomen, the constant 
wearing of a soft woolen abdominal band will in many 
cases do a great deal toward warding off these distressing 
attacks. 



HINTS ON NURSING 379 

CONSTIPATION 

Too much emphasis cannot be placed on the impor- 
tance of a regular, normal movement of the bowels. In 
most cases, this means at least one evacuation daily. 
One disadvantage of the rest treatment for tuberculosis 
is its tendency to induce or aggravate constipation (of 
the atonic type — see below). Nevertheless, rest is so 
essential that ordinarily it should be persisted in, and 
other measures adopted if necessary for the relief of 
constipation. Whenever possible, the result should be 
achieved by natural methods. 

The Two Types of Constipation. Before going 
further it seems well to explain that there are two 
distinct types of constipation, each of which requires 
somewhat different treatment. 

1. Atonic constipation is due to a weakness of the 
muscular coat of the bowel, so that the fecal mass is 
not propelled onward as rapidly as it should be. Mean- 
while, the moisture is gradually absorbed from the 
bowel contents, so the characteristic stool of atonic 
constipation is fairly large in caliber, dry, hard and 
chunky. The seat of the trouble in this type of consti- 
pation is usually low down in the bowel — that is, near 
the outlet. 

2. Spastic constipation is due to an uneven, and in 
places excessive, contraction of the circular muscular 
fibers in the bowel wall. Here and there this brings 
about a narrowing of the bowel lumen ahead of the 
fecal mass, so that it is actually held back. Accumulation 
of gas and abdominal pain and cramps are more com- 
monly associated with this variety of constipation. The 
typical stool of spastic constipation is rather soft, with 
a tendency to be narrow and ribbon or tapelike. In 
spastic constipation the difficulty is apt to be located 



380 LESSONS ON TUBERCULOSIS 

higher up in the bowel (farther from the outlet) than 
in the atonic type. 

In relieving constipation of either variety, the first 
aid is the formation of the habit of going to the toilet 
at a regular time each day, whether or not there is a 
desire at this time. Just before or after breakfast is 
ordinarily the most suitable time, but in other cases 
some other hour may be better. Needless to add, a call 
coming at any other time should not be neglected. 

The second measure of importance is a proper dietary, 
which must be regulated in accordance with the pre- 
vailing type of constipation. By this means, alone, or 
combined with other natural methods, the most obstinate 
constipation of many years standing can often be com- 
pletely conquered. 

DIET FOR CONSTIPATION 

Atonic Type. 

General Rule: Avoid highly concentrated foods; eat 
plentifully of foods that leave a relatively large 
amount of undigested residue, or "roughage." 

Permissible Articles. Fruits, fresh or cooked; espe- 
cially, figs (dried or fresh), prunes, and to a less extent, 
apples, pears, oranges, berries (except blackberries). 
Coarse breads, such as brown, graham (whole wheat) 
and rye breads. The coarser cereals, such as rolled oats, 
Uncle Sam and Pettijohn's Breakfast Food, and in 
general, breakfast foods containing flaxseed or bran. 
Coarse green vegetables, including: spinach, kale, mus- 
tard and other "greens"; asparagus, string beans, 
lettuce, artichokes, brussels sprouts, etc. Olive oil or 
salad oil (cottonseed oil). Buttermilk, or artificially 
soured milk, in preference to sweet milk. 

Most persons drink too little water, so cold water 
should be drunk freely (unless there be some good 
reason for not doing so). 



HINTS ON NURSING 381 

Note: Attention should be called to the fact that 
while the above foods are of much aid in preventing and 
curing constipation, some of them contain but little 
nutriment ; hence it is necessary to avoid falling into the 
error of giving so much attention to the relief of consti- 
pation that nutrition and energy are slighted. Care 
should be taken to see that the dietary contains a 
sufficient quantity of nourishing foods. Bear in mind 
that it is more important for the sick person to receive 
sufficient nourishment than it is for the constipation to 
be controlled by the dietary. If necessary, it is better 
to resort to artificial means to move the bowels than to 
restrict the intake of really necessary foods below the 
safety level. 

So, too, many of the articles of food useful in relieving 
atonic constipation are inclined to irritate the stomach. 
So when the stomach is sensitive, the rule should be to 
humor this organ and to approach the treatment of 
constipation in some other manner. 

In severe and long standing cases of atonic constipa- 
tion, the following simple program will often give 
excellent results, if not barred by one or more of the 
factors just mentioned: Eat a dish of stewed prunes, 
and take one or more tablespoonfuls of bran in water 
or in any convenient way, at each meal. At bedtime 
and on arising, drink slowly one or two glasses of cold 
water. At all meals, eat in addition as many of the 
other laxative foods as prove practicable. 

Spastic Type. 

The coarse foods useful in relieving atonic constipation 
are inclined to aggravate constipation of the spastic 
type. The following foods are indicated: — 

Fruits: pears, peaches, prunes, apricots (not figs). 
Breads : stale white bread, toast, zwieback. The coarse 
breads mentioned for atonic constipation are to be 



382 LESSONS ON TUBERCULOSIS 

avoided. Cereals : mild, soft breakfast foods, Cream of 
Wheat, cornmeal mush, puffed or flaked wheat and rice, 
boiled rice. Avoid coarse cereals. Soft vegetables : peas, 
carrots, turnips, squash, pumpkin; mashed and baked 
potato (in moderation) ; hominy (well chewed). Avoid 
coarse vegetables. Miscellaneous: honey, marmalades, 
jellies and jams; olive oil or salad oil (cottonseed oil). 
Warm or hot water taken liberally (unless otherwise 
contraindicated). Avoid cold water. 

In atonic constipation, the object is to eat foods that 
leave a residue after digestion, which will supply bulk 
to the fecal mass and mechanically irritate and stimulate 
the bowel muscle to propel the contents onward. In 
spastic constipation, on the contrary, the aim is to select 
foods that are not mechanically irritating, the purpose 
being to soothe the mucous membrane and to allay spasm 
of the muscular layer of the bowel wall. 

Massage of the abdomen is a supplementary measure 
of considerable value when the atonic form of constipa- 
tion predominates. When an experienced masseuse is 
unobtainable, the massage may be given by the nurse 
or other attendant; or, if the patient is not too ill or 
weak, he may, if necessary, administer the treatment 
to himself. 

Directions for Giving Abdominal Massage. The 
patient lies on the back, with the knees bent and thighs 
elevated to assist in relaxing the abdominal muscles. 
Breathing slowly and rather deeply through the mouth 
will help in securing relaxation. Warm the hand, if 
cold, and lay the fingers and perhaps part of the palm 
flat on the abdomen, near the navel. Begin with a 
light, circular motion about the navel, gradually widen- 
ing the area covered to a diameter of say six inches, 
and, as the massage is continued, progressively increase 
the pressure, until finally the abdominal wall is prest in 



HINTS ON NURSING 383 

quite deeply and firm pressure is being used. After thus 
spending a few minutes massaging the central area 
(over the small bowel), the same plan should be followed 
in massaging the colon (the large bowel). For this 
purpose, the massage is started low down on the right 
side of the abdomen, and, as the hand is moved in rather 
narrow circles, the massage is progressively continued 
in a sort of U-shaped curve — upward to the edge of the 
ribs, then across to the opposite side, and finally down- 
ward on the left side to the lower limit of the abdomen. 
At this point, the pressure should be even deeper and 
firmer, to reach the backward bend in the bowel known 
as the sigmoid flexure, where much of the trouble is 
commonly located. At no time should the motion be 
violent, nor should the pressure be so intense as to cause 
pain. The massage should be given daily for fifteen or 
twenty minutes. 

Caution: Massage should not be given in the event 
of serious complications in the abdomen, such as appendi- 
citis (acute or chronic), nor when tuberculosis of the 
bowel is present. Likewise, massage is contraindicated 
when the spastic type of constipation prevails. (As a 
matter of fact, spastic constipation is likely to be 
benefited by any measure that affords the bowel compara- 
tive rest, and is often relieved by rest in bed.) 

In spastic constipation, the application of a hot com- 
press to the abdomen for an hour or two, one to three 
times daily, is a simple measure of much value. 

Treatment for Mixed Types of Constipation. When 
the two types of constipation are associated, or when 
they alternate in the same case, as is fairly common, a 
sort of compromise plan of treatment must be adopted. 
Also, fortunately, certain measures are serviceable alike 
in both types. Two such measures are the paraffin oil 
treatment, and the treatment with agar — either of which 



384 LESSONS ON TUBERCULOSIS 

may be administered in conjunction with other measures, 
and both of which are harmless. 

Paraffin oil is a clear, colorless, tasteless and odorless 
oil, which is not, to any appreciable extent, digested or 
assimilated, but which serves as a most excellent internal 
lubricant, aiding also in softening the feces and in 
general facilitating the passage. The dose is the amount 
that is needed. No fixt dose can be set, but experiment 
will determine the proper dose in each case, which can 
often be reduced after a few weeks or a month or two, 
and perhaps eventually discontinued entirely. A table- 
spoonful three times daily is a good beginning dose — 
later to be increased or reduced as required. 

A number of highly purified, excellent paraffin oils 
are on the market, any of which may be taken. Some of 
these oils are a little heavier than others; in certain 
cases the oils with heavier body are more efficient. 

Agar, or " vegetable gelatin,' ■ a preparation made 
from a Japanese sea-weed, has the property of absorbing 
and retaining an unusual amount of water. When eaten, 
the agar absorbs water and swells, forming a soft, jelly- 
like substance which serves to keep the bowel contents 
soft and, like paraffin oil, also serves as a sort of internal 
lubricant. Practically speaking, agar is not digested 
or assimilated, so has no food value. Like the oil, agar 
is absolutely harmless. It is also practically tasteless. 
For the purpose of relieving or curing constipation, agar 
is sold in the form of small granular flakes, which can 
be conveniently sprinkled over breakfast food, eaten 
dry, or dropt into a little water or milk. Agar should 
not be cooked. The dose is two teaspoonfuls, more or 
less, as required, taken three times daily; later increased 
or diminished as found necessary. 

Neither of these preparations has medicinal value, and 
they are not to be looked upon as ordinary laxatives. 



HINTS ON NURSING 385 

Let it be understood, also, that no immediate effect is 
to be looked for. However, when agar is taken, the 
good effect usually begins to show within a week ; altho 
sometimes a longer period is required. As a rule, the 
oil must be taken longer, in obstinate cases for a month 
or more, before improvement is noted. By perseverance 
in the use of one or the other of these preparations, the 
whole tide of affairs can usually be changed and the 
habit of taking daily some laxative or purge, which 
from necessity may have been persisted in for years and 
years, made unnecessary. 

In connection with the oil treatment, in some cases, 
there is one disagreeable feature — the escape of a certain 
amount of the oil when passing gas. This is sometimes 
an indication that too much oil is being taken. Again, 
it may result from taking all of the oil at one large 
dose, as at bedtime, instead of distributing it in three 
smaller doses throughout the day. In still other instances, 
the difficulty is due to the use of an oil having too light 
a body; in this event, the leakage may be controlled 
by procuring a heavier oil. In some cases, this annoying 
feature continues despite all precautions. When this is 
true, if the oil and agar treatments are combined (if 
both preparations are taken) the leakage will nearly 
always cease. Moreover, the combined oil-and-agar treat- 
ments seem to have a better effect in certain cases than 
either alone. 

Oil enemas, retained over night, are also of much value 
in both types of constipation. In giving the oil enema, 
the patient lies on his left side with hips slightly elevated, 
while from one to five ounces of warm oil (olive oil, 
salad oil, or paraffin oil) is allowed to run slowly into 
the bowel. One ounce is a suitable dose at first; this 
may gradually be increased to four or five ounces. At 
first the treatments are to be administered every night. 



386 LESSONS ON TUBERCULOSIS 

Later, with improvement, the interval should be gradu- 
ally lengthened to a week or longer, and the amount 
of oil progressively reduced. If found necessary, a pad 
may be worn to avoid soiling the night clothing. A 
fountain syringe may be used for administering the oil, 
but as the oil has a tendency to glue the sides of the 
rubber bag together, it is better to use a metal con- 
tainer , or to detach the tube from the bag and connect it 
with a funnel into which the oil is slowly poured. If 
administered by the nurse, a soft rubber rectal tube may 
be substituted for the ordinary hard rubber tip, and 
inserted a number of inches into the rectum. This has 
a certain advantage, in that it allows the oil to enter 
the bowel at a higher level. 

Dilatation of the rectum is yet another valuable meas- 
ure in both types of constipation. For home use, a set 
of rectal dilators made of hard rubber or other material 
may be procured. In their use, the small dilator is first 
greased, gently inserted, and allowed to remain for say 
five minutes. Thereafter, the next size dilator may be 
inserted. Perhaps it may be necessary to persist in 
using one size for several days or even weeks, ere it 
becomes practicable to insert the next larger dilator. 

Medication. Medicines for constipation are, at 
times, the lesser of two evils. When this is true, some 
gently acting preparation, such as cascara, compound 
licorice powder, A. B. S. and C. tablets, or Phenolax 
wafers, taken at bedtime, will usually serve the purpose. 

Occasionally, in case a large amount of fecal material 
has accumulated in the bowels, which it is desirable to 
remove at once, stronger medication may be needed. In 
this event, one or more doses of salts (or other saline), 
of castor oil, or one or more compound cathartic pills, 
may be given. Under no circumstances should the com- 
pound cathartic pills be taken for more than three days 



HINTS ON NURSING 387 

in succession. In lieu of these preparations, some form 
of enema (rectal injection, for which see "Household 
Measures" later in this lesson) may be used. Note: 
It is usually a poor plan to continue the injections day 
after day, and week after week. If this is unavoidable, 
the amount of fluid in the enema should be as small as 
practicable, to avoid unduly stretching and weakening 
the bowel muscle. 

The insertion of a glycerin suppository at the time 
when a movement would naturally be expected, may 
bring on an evacuation and aid in the formation of a 
regular habit. The habitual use of suppositories should 
be avoided. 

In certain cases, the application of continuous pressure 
and support to the abdomen (as described near the be- 
ginning of this section on stomach and bowel disturb- 
ances), will materially assist the normal functioning of 
the bowel. 

SLEEPLESSNESS 

Insomnia, or loss of sleep, is an annoying feature in 
many cases of tuberculosis. In most cases, however, by 
careful attention to apparently trifling points in the 
health regimen, the sleeplessness can be controlled with- 
out resort to drugs. Fortunately, too, because bad air 
is back of many a night of broken rest, persons prone 
to wakefulness often experience profound relief almost 
at once on taking up the open-air life in earnest. 

General Measures for Relief. Stomach and bowel 
disturbances, accompanied by delayed digestion and gas 
formation, are frequently provocative of restless, tossing 
nights. So a good general rule is to take a compara- 
tively light evening meal, and to eat it rather early. All 
foods prone to produce gas should be avoided at all 
times, but especially at this meal. Constipation, if pres- 



388 LESSONS ON TUBERCULOSIS 

ent, should be conquered. Relief of constipation, alone, 
has served to cure many an obstinate and protracted 
case of insomnia. (For details of treatment of these 
conditions, the reader is referred to the appropriate 
pages in this lesson.) Ordinary coffee and tea should be 
abstained from, especially after mid-day. (For con- 
firmed users of coffee, one of the de-caffeinized prepara- 
tions of genuine coffee; or, again, a coffee substitute, 
such as those mentioned under the caption " Beverages,' ' 
in Lesson X, may be used.) 

Attention given to the following apparently negligible 
matters will probably be of help: (1) The use of a 
high pillow, or the semi-sitting position. This posture 
serves to lessen the amount of blood in the brain and 
to quiet mental activity. (2) The moonlight or other 
light should not be allowed to shine in the eyes. A 
screen of some sort can usually be arranged to obviate 
this difficulty, or a black band may be worn over the 
eyes. (3) The bed clothing should be as light as is 
consistent with comfort. Both chilliness and excessive 
warmth are to be avoided. (4) In suitable cases, a hot 
bath ; a warm sponge ; or a hot footbath, to which mus- 
tard may be added — taken at bedtime, will prove of much 
value. During cold weather, due caution to avoid the 
acquirement of a cold must be taken, and it may prove 
best to omit the hot bath at this time (the more so, 
because most persons sleep best during cold weather). 
If cold feet provoke wakefulness, some form of foot 
warmer — to be dispensed with as soon as possible — may 
prove a sovereign remedy. (5) Massage of the whole 
body (with care in manipulating the chest muscles) is 
another valuable measure. (6) If sleeping during the 
day interferes with rest at night, it may be well to avoid 
sleep during the afternoon rest hour. 

Importance of Correcting the Mental Attitude. Very 



HINTS ON NUESING 389 

pronounced cases of insomnia can be relieved by the 
formation of healthy habits of thought. Just as sleep- 
lessness is initiated or made worse by brooding and 
worry, by fear and joy — by mental excitement of any 
nature — so the correction of these faulty habits by care- 
ful daily training of the mind will, in many cases, cut 
the bonds that hold one from sleep. 

First of all, try hard to make up your mind that you 
will go to sleep. Even more important: Make up your 
mind that if you do not go to sleep promptly, or if you 
are disturbed by repeated periods of wakefulness, or 
half -wakeful states, and distressing dreams — that you 
will not worry because you do not sleep. Remember 
that persons who are constantly at rest do not require 
as much sleep as if they were up and around. Of 
course it is best for everyone to obtain his or her full 
quota of refreshing sleep (tho all do not require the 
same amount) ; but remember that one can get along 
and get well, despite the fact that for years and years, 
one gets astonishingly little sleep. If when seeking 
sleep, you will resolve firmly that if you later find your- 
self awake, you will not worry and brood over the fact 
that because you are losing sleep, you are wasting valu- 
able time ; if you will renew this resolution each night, 
the first thing you know, you will be pleasurably sur- 
prized to find yourself sleeping much better. Also, in 
this connection, it may pay you to read the little books 
by Dr. George Lincoln Walton, entitled "Why Worry ?," 
"Those Nerves" and "Peg Along." 

Another thing : Make it a plan to put out the lights at 
a regular time and to seek sleep promptly. This plan 
should be adopted when the other regulations for re- 
covery are first put into effect, and zealously adhered 
to thereafter. Regularity in habits means a great deal ; 
therefore in most cases it is unwise to continue reading 



390 LESSONS ON TUBERCULOSIS 

at night in the hope that one will grow sleepy. Do not 
put off adopting this plan, but put it into effect at the 
beginning. It is much easier to make the break com- 
pletely and at once: easier to get out of all the old 
ruts at one and the same time. However, if you have 
not previously adopted the motto, lights out and to sleep 
at a set time each night, adopt this motto now. It is one 
habit that will do you good. 

Third: Avoid taking your troubles to bed with you. 
Resolve that you will put them from you. If they per- 
sist in revolving through your mind, fix you attention 
on some pleasurable experience you have had in the 
past. Or, if you have noticed that you sleep better when 
it is raining, as many do, just imagine that you are 
listening to the steady drone of rain on the roof. If 
the distressing thought recurs, cast it aside again. Do 
not feel concerned because you do not immediately 
succeed in putting it from you, once and for all. Bear 
in mind that this experience is a common one, in no wise 
peculiar to you; that thousands of others have gone 
through the same distressing period when it seemed that 
they could not conquer the persistently intruding 
thoughts. Yet in the end, they have won. If you will 
consistently persevere in this attitude toward distressing 
memories and unwelcome thoughts, night after night, 
you will eventually be rewarded by a night of refreshing 
sleep. Keep on — and your triumph will become 
complete. 

Fourth : Do not attempt to settle business matters or 
other problems at night. The chance is small that you 
will succeed in settling properly at night a matter that 
you were unable to settle during the day, when you were 
wide awake and thinking clearly. Make it a plan, never 
to take up after three in the afternoon anything that 
tends to excite the mind. If there is some matter that 



HINTS ON NURSING 391 

can be settled by giving a little time and attention to it 
during the day, and if it is at all possible for you to do 
so without harming yourself materially, just interrupt 
your rest program for a day to be given over to the 
satisfactory settling of the problem. Then, with the 
difficulty ended and your mind freed of its load, you 
will be in condition to gain full value from the rest 
regimen. 

Fifth: In obstinate cases of insomnia, a change of 
environment or scene may prove of benefit. This is the 
more likely if you are dissatisfied with any particular 
feature of your present surroundings. If discontent 
causes persistent unhappiness, or if you are continually 
at swords-points with those around you, the first thing 
is to see if the fault is not your own. Remember that 
it does no good to bemoan your fate. This serves only 
to hold you back, and is fair neither to yourself nor 
to others. Don't be a grumbler. Make up your mind that 
you will see the bright side. It is almost never so dark 
that there is not light somewhere, if you will but look 
in the right direction. Try your utmost to get in 
harmony with your surroundings, in tune with those 
around you. If you find yourself unable to do so, and 
getting more and more dissatisfied, do not decide that 
you are doomed to fail, but make up your mind that 
you will surmount all obstacles, and that you are going 
to win. Of course, if your condition and other factors 
permit you to change your abode, and if you can find 
some new scene and surroundings where the general 
atmosphere is congenial, then you should make the 
change. But if you cannot, steel yourself to win, anyway. 

The Question of Climate. In obstinate cases of in- 
somnia, the effect of climate may be worth considering. 
In the lesson on climate attention has been drawn to 
the fact that for some persons high altitudes have a 



392 LESSONS ON TUBERCULOSIS 

tendency to induce or aggravate nervousness, to cause 
restlessness and to provoke wakeful nights. On the 
other hand, hot weather often begets sleeplessness, and 
a change from a warm climate to the cool, refreshing 
nights at a higher altitude not rarely brings prompt 
relief. Restless nights are also common in localities 
where the air is very dry and surcharged with electricity, 
especially if strong winds prevail. A change to a lower 
altitude ; or, if living in a hot climate, perhaps to a higher 
altitude, or to some point where the air is cooler ; or if the 
atmosphere is inordinately dry, to some locality where 
the air is slightly moister, perhaps may prove wise. In 
no circumstance, however, should the decision be based 
on one factor alone, but only on a careful balancing of 
all elements in the case. Also, before deciding definitely 
on a change, the most careful attention should be given 
to Lesson XII, especially to the sections dealing with 
the question of advisability of climate change, rules for 
making the journey, and warning against the wanderlust, 

Other Helps. If you are accustomed to turning over 
frequently and thrashing about in bed, try this: On 
putting the light out, lie in one position for a long time, 
force yourself to remain in this position until it becomes 
almost unbearable ; retain this same attitude still a little 
longer, then turn and seek a more comfortable position. 
Sleep will often follow. The same procedure may often 
be adopted during a wakeful period in the middle of 
the night. 

If your condition permits of your sitting up a little 
each day, it may be helpful for you to take all or part of 
this allowance just before seeking sleep. If you are 
allowed to walk, a short stroll at this time may prove 
beneficial. 

In case the insomnia is very pronounced, it may per- 
haps be advantageous for you to move about a little 



HINTS ON NURSING 393 

more than you would otherwise allow yourself. If your 
condition as a whole seems to demand absolute rest, still 
under the circumstances it may prove best for you to 
step over the line just a little. For example, try sitting 
up for a quarter or half an hour before bedtime. Either 
of these procedures will tire you a little, so sleep may 
come more naturally. 

In some cases sleeplessness seems to be due to a crav- 
ing of the stomach for food* (a craving which the 
patient may or may not be aware of) and a hot drink 
of milk or chocolate or other light lunch, taken at bed- 
time or during the wakeful period, may aid in withdraw- 
ing blood from the overworked brain or allay the sensa- 
tion of hunger sometimes responsible for the absence 
of sleep, and serve to draw a curtain over the mind's 
activities. 

Medication. When simpler means fail, it is sometimes 
necessary to induce sleep by suitable medication, but 
no drug for this purpose should be taken except when 
prescribed by one's personal physician, and in all cases, 
its use is to be discontinued as soon as possible. 

NERVOUSNESS 

For the general restlessness and "nervousness" associ- 
ated with many cases of tuberculosis, there is, on the 
whole, no remedy so valuable as rest in the open air. 
There are, of course, exceptions to this rule, but for the 
average patient troubled with an attack of "nerves," 
who is sure he cannot rest and relax, rest is really the 
very thing that will soothe and tune down the high- 
strung nerves most quickly. 

Nevertheless, cases occasionally arise wherein the 



* Craving for food or a gnawing or burning sensation is 
sometimes due to excessive stomach acidity, and a teaspoonful 
of baking soda in water or other appropriate treatment (see 
p. 373) may cure the insomnia. 



394 LESSONS ON TUBERCULOSIS 

opposite effect is manifested. Here, the taking up of 
some harmless pastime, or the cultivation of a hobby, 
will often do much toward preventing time from becom- 
ing a drag, and make the " taking of the cure" an easier, 
more pleasant matter. 

The taking of the cold sponge-bath each day, faith- 
fully, is a simple but unmistakably valuable procedure 
for soothing and quieting the overwrought nerves. If 
one is able to be up and about, the "drip sheet/ ' another 
form of cold bath, may perhaps be better in the given 
case. Full directions for employing cold in either man- 
ner may be found in Lesson XV. 

If, however, despite the use of such measures, the 
restlessness is very persistent and pronounced, a slight 
deviation from the rest program may be permissible, but 
should only be undertaken after carefully estimating 
all of the pros and cons. Finally, a change of environ- 
ment or climate may be sought; concerning which the 
same remarks apply as in the case of sleeplessness. 

Household Remedies and Measures 

The following remedies may be safely taken without 
further instructions than those given herein (or on the 
package), and may fittingly occupy a place on the family 
medicine shelf : 

Hoffmann's Anodyne. For pain in the stomach; gas 
on the stomach ; for hiccough ; and as a rapid stimulant 
in case of weakness, faintness or heart failure. Dose: 
one-fourth to two teaspoonfuls, preferably in cold water. 

Aromatic spirit of ammonia. For the quick relief of 
weakness, faintness or heart failure; for sour stomach. 
Dose: the same as for Hoffmann's Anodyne. If a small 
dose (say one-fourth or one-half teaspoonful) of either 
of these remedies is taken, this may be repeated several 
times at fifteen-minute intervals. 



HINTS ON NURSING 395 

Essence of peppermint. For sour stomach, gas on the 
stomach, and mild stomach pain ; also useful as a gargle 
for relieving throat distress and irritating cough. Dose : 
ten to thirty drops preferably in hot water, repeated a 
few times at intervals of a quarter or half an hour, if 
required. 

Spirit of camphor. For gas on the stomach and mild 
stomach pain ; hiccoughs ; and as a mild nerve sedative. 
Dose : ten to thirty drops, mixed first with a little sugar, 
then with water; may be repeated at intervals of a 
quarter or half hour. 

Compound tincture of benzoin. For relieving irrita- 
tion of the throat, to quiet an excessive cough, for an 
acute cold on the chest. Directions : Place a teaspoonf ul 
to a tablespoonf ul in a pint of boiling water, and inhale 
the steam for twenty minutes several times daily. Avoid 
exposure to cold air for at least a half hour afterward. 

Benzoin is also useful for painting cracked lips and 
nipples, chapped hands, etc.; for sealing up small cuts 
and abrasions, and the like. 

Turpentine (chemically pure) . For the relief of throat 
distress and cough ; for acute cold on the chest : used in 
the same manner as benzoin. Internally: for intestinal 
fermentation and gas formation. Dose : five to ten drops 
on a lump of sugar, three or four times daily. 
Caution : Not to be taken in case of known kidney dis- 
turbance. 

Asafetida. For gas on the bowels ; also sometimes of 
service in allaying nervousness. Dose : three to five grains 
in pill form three or four times daily. 

Aspirin. For relieving sundry aches and pains, head- 
ache, etc.; for lowering fever, and by allaying these 
symptoms, indirectly promoting rest and sleep. Usual 
dose: a five grain tablet, followed by a half glass of 
water, repeated at three-hour intervals if necessary. A 



396 LESSONS ON TUBERCULOSIS 

half tablet may suffice. Caution: Remember that 
aspirin merely gives relief, that it has detrimental as 
well as good effects, and that it is to be taken only 
occasionally, 

lodin. Counterirritant, antiseptic, etc. For the 
relief of pleurisy and other painful conditions, including 
muscular aches and pains, neuritis ; for irritative cough 
and throat symptoms, etc. Directions: Paint a thin 
coat over the seat of pain. For throat distress and cough 
paint on sides and front of neck ; do not paint the throat 
itself unless so instructed by physician. If the skin is 
found not to be sensitive, two or more coats may be 
applied on subsequent applications, if desired. Renew 
every day or two, if required and the condition of the 
skin permits. 

"New Skin" — flexible collodion. Useful in protecting 
the skin from breaking as the result of continued pres- 
sure, particularly over bony prominences. When in any 
such place the skin becomes angry and reddened, place 
a circular wisp of cotton over the area, and paint over 
with either flexible collodion, or "New Skin." Note: 
The taking of pains to see that the very ill invalid does 
not rest too long in one position ; especially on the hip 
or other parts where the bones are prominent ; the use 
of a circular rubber water pad, a pneumatic rubber pad, 
or a home-made O-shaped pillow; the daily careful 
massaging or rubbing of the body as a whole, giving 
particular, tho very gentle attention to all such parts — to 
enliven the circulation — will obviate most bed sores. 

Preparation for keeping the skin healthy. Powdered 
alum, one teaspoonful, alcohol and sweet oil, each one 
half pint. Shake well before using. Useful for rubbing 
the skin daily, and for preventing bed sores. 



HINTS ON NURSING 397 

ENEMAS OB RECTAL INJECTIONS 

All injections are preferably administered by gravity 
(with a fountain syringe or enema can), and the solution 
should be warm and allowed to flow in slowly (ten or 
fifteen minutes being consumed in the operation) while 
the patient rests reclining. The entrance of the fluid 
to the higher parts of the bowels is usually facilitated 
by lying on the left side with the hips elevated. If the 
condition of the patient permits, later assuming the 
prone position for a few moments, then rolling clear over 
onto the right side, and finally resting on the back is 
sometimes advantageous. One pint to two quarts of 
fluid is usually sufficient. If possible, this should be 
retained ten to twenty minutes. 

The Salt or Saline Enema. Prepared by adding a 
teaspoonful of table salt to each pint of water. For the 
relief of constipation when a stronger enema is not 
required. Also for cleansing the bowels during diarrhea, 
to relieve gas pains, etc. 

The Soapsuds Enema. As its name implies, this enema 
is prepared by dissolving a greater or less quantity of 
soap in water. For constipation, when more assistance 
is needed. 

The Compound Enema. Two teaspoonfuls to one 
ounce of turpentine, one ounce of epsom salts, and one 
ounce of glycerin, are mixed with one quart of water as 
hot as can comfortably be borne. For constipation when 
still greater stimulation of the bowels is required; to 
aid in the expulsion of gas from the bowels. 

Asafetida Enema. Made by adding two to six ounces 
of "milk of asafetida' ' (obtainable at the druggist's) to 
a convenient quantity of water. Very useful for cleans- 
ing the bowel and for the relief of pain and discomfort 
from gaseous distention. 



398 LESSONS ON TUBERCULOSIS 

COMPRESSES AND STUPES 

The Cold Compress. Made by wringing out a piece of 
flannel in cold or ice-water, placing on the desired spot, 
and covering with a little larger piece of dry flannel or 
oiled silk. Caution : Care should be taken to see that 
the wet cloth is thoroughly covered, so that air cannot 
enter around the edges. For the relief of irritating 
cough, hoarseness, pain in the throat, pleurisy, etc. 

The Hot Compress. Made in the same manner, but 
with very hot water. The compress should be applied 
as hot as can possibly be borne without burning. 
Caution: In applying, and especially in removing 
the compress, care should be taken to avoid undue ex- 
posure. For pleurisy and pain in the chest, abdominal 
pain and cramps, gas on the bowels, etc. 

Turpentine Stupes (or fomentations). Prepared in the 
same manner as the hot compress, after which thirty 
drops of turpentine is immediately sprinkled on the 
hot, steaming cloth. Caution : Not to be used in case 
of known, genuine kidney disturbance. For abdominal 
pain, gas on the bowels, etc. 

The Mustard Plaster. Prepared by mixing mustard 
and flour into a paste with warm water, and spreading 
onto old linen. A thin piece of gauze or muslin should 
be placed between the mustard and the skin. The plaster 
should be allowed to remain on only until the skin is 
thoroughly reddened, which usually means for fifteen 
minutes or so. For pleurisy, "cold on the chest,' 9 for 
nausea ajid vomiting (applied over the pit of the 
stomach) ; for the relief of pain in the abdomen (applied 
over the painful area)* 



HINTS ON NURSING 399 

GENERAL MASSAGE 

Massage of the body of the bed patient contributes 
greatly to his comfort, and is useful in promoting sleep 
and the general well-being. 

With the patient lying on his back and at ease, while 
the muscles are thoroughly relaxed, the attendant gently, 
but firmly, picks up and squeezes or kneads the indi- 
vidual bundles of muscles or muscle-groups throughout 
the body, passing in a systematic manner from one part 
to the other. This is followed by gentle friction of the 
surface with the fingers and palms, at first very light, 
then firmer and firmer. When rubbing the extremities, 
the movement should be made toward the heart, in 
order to aid the return of the impure blood. Placing the 
palms of the hands near together, and then tapping the 
body with rapid, vertical strokes made with the side 
of each hand alternately, is a useful variation. Finally, 
in suitable cases, the attendant may flex or bend back 
and forth the various joints of the extremities (passive 
motion). Caution: Throughout the treatment, ex- 
traordinary care should be used not to use too much force 
or pressure in massaging the skin or muscles of the 
chest. Also, passive motion is not to be used on very 
ill or very weak patients. All massage is, of course, to be 
eschewed at times of hemorrhage. 

If desired, cocoa butter or some other emollient may 
be used to render the skin more flexible. Note, however, 
that contrary to a popular opinion, cocoa butter, applied 
in this manner, has no practical value as a food. 



LESSON XIV 
WHEN "BLUE" DAYS COME 

Priceless as it is, in helping to restore the pulmonary 
invalid to a life of usefulness, rest, like all other beneficial 
measures, has its objectionable features. Eest makes it 
necessary for the patient to be more or less isolated from 
the affairs of the world, so he is called upon to find 
some other way in which to occupy his time. With but 
few persons to converse with when taking the "cure," 
it is natural to spend a good many moments in com- 
muning with oneself. For most persons, time whiled 
away in this manner is harmlessly spent in day-dreaming 
and building air-castles for the future. Others, however, 
are prone to convert the idle hours into mischief — to 
waste their energies in moodily pondering and brooding, 
in anxiously looking forward to misfortune, and in 
general, in building up house after house of worry and 
discontent. 

Preventives and Antidotes for Fear and Dread 

Here then, it may be well to take up one by one the 
common causes for anxiety and, by careful investigation 
and analysis, see if we cannot devise effective preventives 
and antidotes for the dragons of gloom and worry. 
Before doing so, however, it may be well to give a 
moment to asking a question or two, the answers to 
which will help to keep up your courage and hope until 
the antidote takes, full effect. 

A Significant Incident. Do you not recall some day 
when even the most simple, commonplace matters ap- 

400 



"WHEN "BLUE" DAYS COME 401 

peared to have suddenly acquired the faculty of twisting 
themselves into the most knotty, insolvable problems? 
Do you recollect how at night you have lain awake for 
hours trying to reason the thing out, and how the longer 
you reflected on the matter, the more tangled and 
jumbled it became? How immediately following each 
momentarily cheering thought difficulties presented 
themselves so rapidly and continuously that finally a 
dark mantle of gloom and despair settled down upon you, 
and you became certain that there was no way out ! 

Yet after all, how when the shadows of night were at 
last lifted and the sun came out in its full glory, at 
once the mist cleared from your brain, and gloom and 
despair were displaced by a wonderful feeling of re- 
newed confidence and happiness? How on looking back 
on the long black night, you wondered what could have 
given you so despondent a turn of mind, and laughed at 
the imaginary bogy you had conjured up for yourself ? 

No doubt you have had this experience. Do not forget 
it. Some day when you strike a bad spot on the road to 
health ; when deep in your heart you feel that you are 
going to mire down right there for good, just recall 
this incident, and you will see that matters are not so 
serious as they appear. 

No Cause for Alarm Merely Because One Grows 
Worse for a While. Returning to the preventives and 
antidotes, we shall begin by assuming that before taking 
up the "cure" you had been losing weight quite rapidly 
and on the whole going from bad to worse. If this is 
true, there is no need to be disappointed if you do not 
begin to pick up immediately, or even if for a time you 
continue to fail. 

Just think of yourself as being in an automobile that 
has temporarily gotten out of control and is racing 
down a steep hill. Picture yourself as endeavoring to 

26 



402 LESSONS ON TUBEKCULOSIS 

check and stop the speeding machine, so that you can 
turn round and go up the hill again. In doing so, it 
will first be necessary for you to slow down gradually 
and to bring the machine to a full and complete stop, 
ere you can turn it around and slowly reclimb the grade. 

So, if you have lost control of your health and find 
yourself going faster and faster on the down grade, if 
you will keep a stiff upper lip and a firm grip on the 
wheel, the chance is large that you will regain control. 
Bear in mind, however, that, notwithstanding all efforts, 
you will continue going downward for some time. A 
gradual slowing up of the downward course is the best 
that is to be expected for quite a period; later, after 
a stationary point has been reached you will begin to 
gain in weight and strength, realizing, as improvement 
thus becomes evident, that you have really been on the 
mend for some time. 

Do Not Worry Because You Have Always Been Thin 
and Frail: This May Even Be a Point in Your Favor. 
Are you apprehensive because you have been thin and 
frail as far back as memory carries you? If so, then 
bear this in mind: As a matter of fact, this may be a 
point in your favor. Altho you have heretofore been 
going about your daily affairs perhaps wholly oblivious 
of the fact that something has all the time been holding 
you back, keeping you always behind the vanguard^ 
nevertheless the likelihood is large that for years, per- 
haps since earliest childhood, somewhere in your body 
you have been harboring a hidden, more or less dormant, 
focus of tuberculosis. Assuming this to be true, the very 
fact that the disease has not gotten the better of you 
long ago is strong proof that you have considerable 
resistance against it. Now that the condition has been 
recognized and you have settled down to the business 
of freeing yourself of the encumbrance, this resistance 



WHEN "BLUB" DAYS COME 403 

will prove of much aid to you in throwing off the handi- 
cap. Once rid of the burden for all time, you will then 
be in position to take your rightful place in affairs, and 
get out of life a keen enjoyment which you had not 
dreamed had existence before. 

The Bogy of Heredity. Are you worrying because 
several members of your family before you have died 
of tuberculosis; feeling, therefore, that you, too, are 
marked out to fail? Have you said to yourself: "If I 
am predestined to lose, why take up the fight at all?" — 
Then remember that in all likelihood a careful inquiry 
will bring to light a definite and sufficient reason why 
those dear to you failed to attain victory. You are almost 
sure to find that one or more mistakes were made some- 
where; pitfalls which you, by plainly visualizing them 
in advance, can easily avoid. Remember, too, that at the 
worst, the inherited soil is almost never so fertile that 
by right methods it cannot be rendered unfit for the 
growth of the seeds. 

Past Failures Do Not Presage Present Failure. Or 
perhaps you, yourself, have made one or many previous 
attempts to win back your health, but have so far failed 
to achieve permanent success. Perhaps you are beginning 
to think: "Yes, I can be patched up for awhile, but then 
I will break down again ; so what is the use of trying, 
anyway? I might as well give up now and have done 
with it!" 

No. By no means give up the fight ! Perhaps you have 
been following the wrong road. Perhaps you have not 
been consistent in your efforts, concentrating your atten- 
tion always on the one object. Perhaps you have wavered 
in your course from time to time and have slipt back 
a little. Or again, tho you may have so far kept bravely 
on the right road, may it not be that you have been in 
too much of a hurry; that you have not correctly 



404 LESSONS ON TUBERCULOSIS 

calculated the time element? Remember, that even tho 
right methods are consistently followed, time is a highly 
important factor. For example: Many to whom the 
prize seems unattainable at the end of six months, win 
in a year; many who give up after spending a year 
apparently going hopelessly downward, could win in 
two or three years; still others, finding after two or 
three years the thread of life growing ever thinner, and 
concluding that it is useless to continue the struggle, 
could win by bravely pushing onward a year or two 
longer. 

Voyage of Health Often Rough. Now, before set- 
ting sail on your voyage for health, just assume that 
at some point in your course you are going to strike 
rough weather. That perhaps even when least expected 
a storm will suddenly spring up from nowhere — appar- 
ently for no reason at all. Be prepared to face more 
than one spell of this sort without flinching. Remember, 
too, that each spell may differ radically from the one 
that preceded it — that no two storms on the ocean are 
exactly alike. But whatever the exact nature of the 
storm, it will probably upset your calculations and lead 
you to fear the worst. Yet after the wind has blown 
itself out, you will probably find that the interruption 
to your progress has not been serious. More: To your 
intense surprise and keen gratification, you may even 
discover that the stormy symptoms were largely camou- 
flage, and that they drew and held your attention so 
firmly that you did not notice that you were still making 
headway — that your improvement was really going for- 
ward all the time. 

Odd Signs and Accompaniments of Healing 

Improvement Sometimes Comes Cloaked in Disguise; 
so, if some day, out of a calm and untroubled sea, your 



WHEN "BLUE" DAYS COME 405 

fever should begin to rise, with or without an increase 
in the cough and expectoration, do not hastily jump to 
the conclusion that you must have gotten off your course 
and are going backward. Just remind yourself of the 
fact that one must sometimes first grow worse in order 
to get better; then carefully think over the following 
explanation and see if it does not fit your case. 

Fever an Indication That Nature Is at Work. When 
tuberculosis attacks the lungs, to aid in repairing the 
damage Nature sends an increased quantity of blood, 
carrying healing elements and reparative material, to 
the seat of trouble. Thus a sort of inflammation of the 
damaged area is brought about, the result being that 
healing is stimulated. Inflammation, of course, is accom- 
panied by the production of heat, so it is not unnatural 
that the bodily temperature should become higher at this 
time. Other reasons why fever is sometimes associated 
with healing in the lungs are discussed in Lesson IV and 
Lesson VIII. Here it may be well to view the matter 
from still another angle. 

Healing' Brought About by the Separation of the 
Damaged from the Sound Tissue. Once any part of 
the lung has been irretrievably damaged, healing is 
brought about by the gradual separation of the damaged 
from the relatively sound tissue, by a process of softening 
and liquefaction. Just as a boil softens and " comes to 
a head," so the tubercles gradually break down and 
"ripen" — though much more slowly. During this time 
the bodily temperature is likely to be higher, and in 
due course, the cough and expectoration, by means of 
which the softened "core" is little by little expelled, will 
probably become more marked, weight may be lost — and 
in general, one may feel quite ill and discouraged. 
Sooner or later, however, as the period of house-cleaning 
draws to an end, the distressing symptoms gradually and 



406 LESSONS ON TUBERCULOSIS 

progressively subside. Then, with the work of healing 
and repair just so much further along, one is in position 
to begin the storing up of energy and strength to make 
up for the amount expended in the process of elimination 
and repair. 

Nature Does Not Always Complete Her Work at One 
Long, Tedious Sitting. Bear in mind, too, that Nature 
does not always finish the task of casting off the damaged 
tissue, nor complete her repair work, at one long, drawn- 
out " sitting/ ' The reason why this is so is not always 
the same ; nor can an altogether satisfactory explanation 
be given in every instance. For the present, however, let 
us think of Nature as a wise and skilled dentist, guided 
in her work by her estimate of the strength and en- 
durance of her patient. When one has teeth that need 
attention, the dentist knows that it is better not to put 
too big a strain upon his patient at one time. If the job 
is tedious and hard, he does not attempt to complete 
it in one, or even in two or three visits, but has his 
patient return at intervals from time to time, at each 
appointment carrying the repair work a little further, 
till finally the day arrives when the finishing touches 
are added. 

Sometimes it seems that Nature is governed by just 
such reasoning ; at any rate, the effect is the same. From 
time to time, in certain cases, there comes a periodical 
recurrence or increase of the fever, accompanied or fol- 
lowed by an increase in the cough and expectoration ; in 
turn there comes an interval during which the fever is 
low or absent and the cough and discharge diminished. 
This interrupted, wave-like character of the clearing- 
out-reparative process is in many cases distinctly con- 
servative and favorable — the rest periods between each 
little up-wave, so to speak, giving opportunity for the 
building-up of a reserve of energy, which is again drawn 



WHEN "BLUE" DAYS COME 407 

upon at the next "sitting." Thus as the symptoms 
fluctuate first up, then down, with each oscillation, the 
time for the dawning of the day of complete emanci- 
pation draws nearer and nearer. 

Healing Pains. In certain cases it is a strange fact 
that as convalescence approaches, annoying aches and 
pains in the chest or elsewhere become quite trouble- 
some or are noted for the first time. The pain is some- 
times referred to the neck or shoulders, or down one 
or both arms; and may be attributed to rheumatism. 
As a rule, the pain or ache is not severe, but coming just 
at this time, is apt to be a source of worry and discon- 
tent ; for very naturally, it is rather difficult to reconcile 
increasing discomfort with improvement. Such pains, 
often spoken of as "healing pains," or again, as 
"weather pains" — because it is common knowledge that 
they are influenced by atmospheric changes — by no 
means occur in all cases, but if they do occur, need 
cause no alarm. 

Have you not read of some person who, after an 
operation for the removal of his appendix, continued to 
suffer from pain — pain which was so persistent and 
severe that he finally came to the conclusion that his 
appendix had not been removed, and that he was still 
suffering from appendicitis? This sort of pain, and 
the pains and aches in the chest and nearby parts becom- 
ing especially evident as the lungs are healing, are due 
to similar causes — to the formation of healing tissue 
(scars) and protective adhesions or bands, which, like 
scars in all situations, soon begin to shrink and contract, 
pulling upon and pinching the sensitive nerve filaments 
within their reach. 

The scars in the lungs ordinarily require two or three 
years to become thoroughly cemented and set. So, if 
pains recur or continue during this period or longer, 



408 LESSONS ON TUBERCULOSIS 

this is merely to be accepted as Nature's friendly warn- 
ing that reasonable care is still necessary. 

An Example of Nature's Foresight and Generosity. 
Now suppose that you are concerned over a still different 
matter. We shall assume that, for months or years, you 
have raised so large an amount of sputum that you have 
at last become convinced that you are losing the greater 
part of your lungs. If this has been your thought, just 
stop a moment and reflect on the fact that by far the 
larger part of the solid portion of the sputum consists of 
the so-called white corpuscles of the blood (Nature's 
soldiers — described in Lesson IV), many of which are 
dead or hopelessly crippled, and therefore of no further 
use in the fight against the germs. The great bulk of the 
sputum, then, consists of these dead or injured corpus- 
cles, carrying within them a greater or less number of 
tubercle germs, which are in this manner eliminated 
from the body. Only on rare occasions does the sputum 
contain even the most minute shred of lung tissue. If 
you will think a moment, and recall how, when you have 
had a severe cold in the head, an immense quantity of 
discharge poured from your nose day after day, yet 
afterward your nose was apparently as good as ever, 
you will see that the same rule applies in the present 
instance, and that you have probably borrowed trouble 
unnecessarily. 

On the other hand, for the sake of argument, let it be 
taken for granted that you really have lost a large part 
of one or both lungs. Under this circumstance, while 
passing through what seems to be an interminable siege 
of sickness, some such thoughts as the following may 
linger insistently in your mind: "Yes, I may possibly 
come out of this some day: but will anything be left 
of me? What if the fire in my lungs does at last burn 
itself out ? I fear that it will then be too late ; for will 



WHEN "BLUE" DAYS COME 409 

I be worth anything either to the world or myself?" 
Fortunately, Nature herself has answered your ques- 
tions in advance. For Nature has generously endowed 
our bodies with a superabundance of lung tissue, so 
that it is possible for us to live on as little as one-sixth 
of a lung. Kemember, too, that as time goes on, the sound 
portions of the lungs enlarge and to a certain extent 
take on the duty of the air cells that have been put out 
of commission. For these reasons, once the disease has 
been thoroughly conquered, unless its ravages have been 
wide indeed, there will be plenty of healthy cells left 
for the satisfactory carrying on of the respiratory 
functions. 

A Severe Case op the " Blues' ' 

But suppose your case of despondency is very aggra- 
vated and persistent. Suppose that day after day and 
month after month you have been continually thinking 
the same thoughts, futilely trying to solve the same 
problems, till you have gotten into so deep a mental 
rut that it seems that you will never be able to get out. 
Each day you have dwelt on your symptoms anew, 
have threshed the matter out till you thought it was 
settled ; yet a little later the whole thing has come back 
to you in a worse jumble than ever. Now you find your- 
self worrying about every conceivable thing. It matters 
not whether the thing is worthy of attention or thought. 
It matters not that you yourself well know that there is 
absolutely no cause for anxiety; the fact remains that 
you have somehow contracted the habit of brooding. 

Up to the present, moreover, despite your most earnest 
efforts to break the habit, you have been unsuccessful. 

If for an instant you obtain a glimpse of the sunshine 
of hope, almost simultaneously a dark cloud of gloom 
sweeps over and obscures the light. Nothing seems to go 



410 LESSONS ON TUBERCULOSIS 

right, and you see only the dark side of each and every 
occurrence. 

Nor is it always yourself about whom you are con- 
cerned. It may be the welfare of your dear ones, or of 
some friend : it may be some business anxiety. It may 
be both. It may be some very trivial incident in the 
carrying on of some little detail of conversation ; of letter 
writing ; or in the transaction of some necessary item of 
business (and remember that the transaction of any 
item of business not absolutely necessary is strictly 
against the rules) you feel that you have failed to handle 
the matter in the most judicious manner ; it may be that 
you feel you are a little lax in some duty, or on the 
contrary you may feel that you were a little too severe 
in your dealings with this or that problem. Or, again, 
it may be that you are not satisfied with the way some- 
one else tends to the duties that ordinarily devolve on 
you, while you are incapacitated. Perhaps the maid 
fails to keep things looking tidy and neat ; perhaps the 
food is not cooked just right ; perhaps the gardener has 
become a slacker. And so you feel that things are 
generally "going to the dogs' * and worry because you 
cannot get up and boss the job. So whatever the cause, 
you continue to worry. 

If someone tries to comfort you, and points out what 
to him appears to be an error in your point of view, 
you are inclined at first to agree with him; then you 
end the sentence by adding an "if — " or a "but — ." 
Thenceforth you relapse into argument to support your 
pessimistic outlook. Each time that the bright side is 
presented to you, you have a ready answer upholding 
your own darker views. 

You may even become suspicious of your friends, and 
finally arrive at the conclusion that they are simply 
trying to bolster your feelings and cheer you up, irre- 



WHEN "BLUE" DAYS COME 411 

spective of what they really think. You are convinced 
that their real feeling is that there is no chance for 
you. You become doubtful and suspicious of everyone — 
even of yourself. You are now reaching the point where 
you hardly know what to make of yourself. You are no 
longer sure of anything. You may even begin to wonder 
whether you are not losing control of your mental 
faculties; thinking perhaps, "If, on top of it all, my 
mind deserts me, what possible chance will I have?" — 
continuing to carry on the discourse with yourself some- 
what on this order: "Worry has been destroying my 
rest at night and in a thousand ways sapping my meager 
fund of strength and energy. To have wasted this much 
time and energy through brooding and worrying, and, 
in turn, worrying again just because I worry, is bad 
enough; for so long as worry is unconquered I don't 
see how it is possible for my lungs to get well. And as I 
cannot conquer worry, I am doomed to fail. This outlook 
is black enough, but now if, in addition, I lose my 
senses, what will become of me?" 

Having witnessed the suffering of many others who 
have felt this way, and having had a somewhat similar 
experience myself, I have found that to attempt to point 
out the weak places in the argument of the invalid, 
while sometimes successful, yet often fails of its purpose. 
At the time, the invalid is in such a frame of mind that 
he either cannot or will not see hope in any shape, 
form or manner. He persistently searches for proof to 
back up his side of the case, and is nearly always ready 
with a counter-statement which, if not altogether accu- 
rate, is yet sufficiently so to convince him that his view 
of the matter is correct. 

Suggested Remedies. When one has thus gotten 
into a mental morass, so that each movement for extrica- 
tion only causes one to sink deeper and deeper, if one 



412 LESSONS ON TUBERCULOSIS 

will keep as cool a head as possible under the circum- 
stances, it will be found that several ways of escape are 
still open. Many others in the same predicament have 
succeeded in getting out by making use of some very 
simple expedient. Among the following plans it is very 
likely that you will find at least one suited to your 
case : — 

1. Try to imagine yourself as standing in the place of 
a public defender. Against your real wish and will, you 
find it necessary to defend as best you can a client 
whom in your own mind you are convinced is guilty. 
Nevertheless, you are called upon to remember that, until 
actually proven guilty, the law assumes his innocence; 
that your view of the matter may be faulty ; and that, 
at any rate, the commonwealth has employed you to do 
what you can, legitimately, for the prisoner at the bar. 
So you realize that even though your desires are other- 
wise, it is your bounden duty to make every effort to 
discover and tellingly present every whit of evidence 
in his favor. 

Starting from this basis, from now on set your mind 
firmly to the task you have undertaken. Resolve that 
under no circumstances will you allow prejudice or 
previous conviction to stand in the way; that unflinch- 
ingly, unwaveringly, you will delve in every direction 
and seek to bring to light each and every fact that offers 
even the least possible chance of escape. Continually you 
must keep at the job of turning over the evidence, sifting 
it out and searching here and there for points that will 
provide a way out. 

Tho the task seems hopeless, keep at it. Keep dog- 
gedly, persistently on, and first thing you know, little 
by little you will have accumulated enough evidence to 
convince you that your previous viewpoint was wrong, 
and that things are not half so bad as they seemed. 



WHEN "BLUE" DAYS COME 413 

This method is very effectual. I have seen many who 
were at first in the darkest despair, but who unfalter- 
ingly kept on, ever searching for favorable points, who 
were at last overjoyed by having their efforts crowned 
with success; who came out from gloom to hope, from 
hope to confidence, and who finally emerged, fully con- 
vinced that they had won. 

Even if your efforts in this direction are not wholly 
successful, they will at least ease your mind somewhat, 
and carry you along past the quicksands of deception 
and despair, till finally, with the lapse of time, Nature 
brings a turn in your condition, and you are forced to 
see that you are winning. 

2. Choose some time in the twenty-four hours when 
you are feeling at your best, physically. This period 
is to be given over entirely to the purpose of reobtaining 
your mental poise and equilibrium — or, in other words, 
in getting a new and firm grip upon your mental facul- 
ties. Perhaps the evening, just after the lights are out, 
will be the most suitable time for this undertaking. 

At this hour, when things are quiet, with nothing to 
disturb you, it will be easier to concentrate your thoughts 
on the matter in hand. Then, too, worry is perhaps 
most liable to impose itself on one during the night, 
so by setting the brain right before seeking sleep, you 
will be more likely to fall into a soft, restful slumber, 
and this will go a long way toward giving you peace 
and repose at all times. 

First of all, you are to relax your muscles and find 
as restful a position as possible, so that bodily discomfort 
will not distract your attention. Comfortably settled, 
you are to commune with yourself somewhat as follows : 

"There is really no reason why I should worry, for all 
worry is useless. Even tho I am very ill, even tho a 
thousand things have gone wrong, the fact is not altered 



414 LESSONS ON TUBERCULOSIS 

that worry accomplishes nothing. Hence, I am going 
to stop worrying. 

1 ' Others have been just as sick, or perhaps even worse 
than I, and have had just as many troubles; yet have 
not worried. Or, if they contracted the habit of worry- 
ing, they succeeded in breaking it. What others have 
done, I can do. 

" Worry is retarding my progress; it is worse than a 
waste of time. Knowing that it is unnecessary, to allow 
worry to hold me back is pure folly. 

"Our thoughts can be controlled if we try hard 
enough. I can control my thoughts. I will control them. 
Instead of being a slave to my thoughts, I will make 
them serve me. True, this will not be easy to do, but I 
have worked out other hard jobs. Before this, I have 
prided myself on being successful in carrying out what- 
ever I have undertaken. Now, am I to weaken and allow 
little things like my own thoughts to control me ? 

"No. I will continue to be the master. I will prove 
that I can master myself. Thus I will not only help 
myself to reobtain health and happiness, but in time I 
will become able to reassume my part in looking after 
the welfare of those dear to me. Just now, however, I 
am in no condition to do anything for my friends or 
family. Therefore, much as I would like to do this I 
will not fret because I cannot. While I am down and 
helpless, this is not expected of me. To overtax myself 
through attempting to help them now, will only do harm. 
This would only hold me back and perhaps make it 
impossible for me to help them in the future. It would 
actually put a greater burden on the very ones whose 
burdens I wish were lightened. I must wait. I will 
not worry because I am able to do nothing in setting 
things right around me. At present this is not my 
business, and I will not be a meddler in what I should 



WHEN "BLUE" DAYS COME 415 

not allow to concern me. Others must do the carrying 
on at this time. It is but right for them to do what 
they can for me. I must make their labors as light as 
possible by gracefully submitting to the inevitable, and 
resigning myself to resting and relaxing, and accepting 
their assistance. 

"My present duty is to get thoroughly and completely 
well. Consequently, I will not allow injurious thoughts 
of any nature to recur, and hinder this achievement. 
I will concentrate all my efforts on the one thing. 
Meanwhile I will not worry. Later, when I am re* 
stored to my family, whole and well, I will be able to 
make up for lost time in making them happy. Then, I 
will also get full enjoyment out of life itself. But in the 
meantime, I will be patient and wait. In order that I 
may thoroughly recover at the earliest possible moment, 
for the sake of my dear ones as well as myself, I will 
stop worrying. 

"Eight now I am going to make a beginning, by 
putting all annoying thoughts from my mind. I will 
not allow them to return and intrude themselves and 
interrupt my rest and progress. I will sleep more 
soundly tonight." 

The exact words are unimportant, but it is well to 
make use of the ideas they express, unless they are 
obviously unsuitable in your case. Whether or not you 
believe that the plan will prove successful, speak the 
words as tho you mean them. Make each sentence stand 
out. Confidence will come to you as you persist. If 
convenient for you to do so, speak the affirmations aloud. 

Say the words slowly, clearly, thoughtfully. If it does 
not tire you too much, repeat each affirmation at least 
once. Each night, end the little session with your 
thoughts with this formula : 

"Hereafter, when an unwelcome thought intrudes 



416 LESSONS ON TUBERCULOSIS 

itself, I will at once put it from me. I will force myself 
to think of something pleasant or helpful. If the unde- 
sired thought insistently recurs, each time I will resist 
it. No matter if I fail at first, I will consistently main- 
tain this attitude. No matter how many times I fail to 
sidetrack the disagreeable thought, I will persist. In 
the end I will win. I will not allow painful memories 
or harmful thoughts — thoughts that I know to be un- 
necessary — to sap my energies and defeat my plans. By 
persevering, I am going to regain complete control of 
myself, so that my brain will stop working, instantly, 
when I call a halt. 

" Worry is needless: it is harmful. It can be stopt. 
Others have conquered worry, and there is no reason 
why I cannot do likewise. I will succeed. Now I am 
going to compose myself, put aside all troublesome 
thoughts, and in a little while, I shall fall into a restful, 
refreshing sleep.' 9 

Make this session with your thoughts a nightly habit, 
a part of your creed. Let your thoughts attend the 
session regularly each evening at a set hour. In time, 
it is very probable that you will see that you are 
winning. Instead of permitting your nerves to rule you, 
you will assume command and become the master of 
your own destiny. 

3. "Whatever the cause, your brain Jias formed 
the habit of working overtime. Furthermore, we shall 
assume that the habit has already become pretty firmly 
fixt, so it may not be practicable to break it off 
sharply and at once. Instead, why not employ a little 
diplomacy in dealing with the errant organ? Why not 
contract a good habit of thought to counteract the bad 
habit? 

Just think of the brain as a misbehaved child, that 
has been romping boisterously about and getting into all 



WHEN "BLUE" DAYS COME 417 

sorts of mischief and difficulties. Of course, you might 
send the youngster promptly off to bed, and command 
it to keep quiet and go to sleep. But, here your previous 
experiences press forward and remind you that this 
plan has often failed. So you conclude to try another 
scheme. You decide that instead of at once seeking to 
calm and quiet your brain-child by a sharp word of 
command, you will endeavor to guide its activities into 
some different, safer channel. 

Thus, you may adopt some hobby. Almost any kind of 
a hobby will do, provided that it is not in itself harmful. 
Even tho you are confined to bed, some scheme may be 
devised for occupying your attention and brightening 
the dark moments. For example, why not interest your- 
self in the bird life about you? For a small sum you 
can obtain from your bookseller a very neat and handy 
little volume, in which is presented by word and brush, 
accurate and vivid yet short and concise descriptions 
of the markings, traits, songs and general distinguishing 
characteristics of all the birds in your neighborhood, as 
well as a multitude of others. Taken up in even so 
small a way, it is not unlikely that you will become 
more and more interested and entranced with the sub- 
ject, and, what is more to the point, you will soon find 
that you are being helped definitely on your way. 

Or, perhaps some other of the myriad of Nature's 
wonders will offer more attraction to you. Nature is 
everywhere, so no matter where you are, if you will 
but try to forget yourself, and look about you, close at 
hand, or even right from your window may be found 
many things to draw and hold your attention. 

Or, if you find it hard to interest yourself in the 
ordinary manifestations of Nature, perhaps if the nature 
study takes a more practical trend, you will become 
interested. Suppose then, if your condition permits, that 

27 



418 LESSONS ON TUBERCULOSIS 

you take up some correspondence course, on, say, date 
growing, olive culture, bee-raising, or some kindred sub- 
ject that will really help to fit you for future work. 
Most excellent courses of this sort, with membership at 
small cost, have been arranged by many of our large uni- 
versities; and accurate information along still different 
lines may be had from other sources for a moderate out- 
lay. 

Or perhaps some phase of literature or art, of elec- 
tricity or mechanics, or again, stenography or some light 
business course, will prove more attractive and suitable. 

At all events, the aim should be to select some line of 
thought or endeavor that is agreeable. 

Caution: This plan is, of course, not to be con- 
sidered at all unless one is at least fairly well along in 
the convalescent stage. Even then it should be remem- 
bered that study of all kinds is really against the rules, 
and that in allowing oneself a little leeway in this direc- 
tion, one is doing so merely because this appears to be 
the lesser of two evils. 

At the start, make up your mind that you will not 
take up the little project too energetically. Bear in 
mind that you are primarily seeking only a pastime, and 
do not allow yourself to make a task, or even work, out 
of the undertaking — else more harm than good will be 
done. Under no circumstances set yourself to accom- 
plish so much in a given time ; nor allow the reading to 
tire you. Probably it will be best to fix a definite hour 
each day, at which time — with interest but without hurry, 
with pleasure but without intense concentration — slowly 
and rather lazily you dream along from page to page. 

Work for the Fingers May Keep the Mind from Mis- 
chief. On the contrary, you may find that if the hands 
are kept busy, this is the best way to quiet the brain. 
Here then, crocheting, knitting, basketry, art metal 



WHEN "BLUE" DAYS COME 419 

work, picture frame making; or, if you are strong 
enough, some light employment calling for a minimum 
amount of manual labor, such as chair-seating, may 
prove a boon to the excited nerves. "Handicrafts for the 
Handicapped, ' f a little volume by Hall and Buck, may 
aid you in selecting and carrying on the little avocation. 

Again it may be that some form of amusement or 
game will best serve to divert your thoughts from your- 
self and troubles. While you are still in bed, or while 
sitting up, you may make a beginning along this line. 
Later, as you begin to get up and about, it will become 
still easier to select some game as a harmless hobby or 
pastime. This will help to remove that feeling of com- 
plete idleness and help to pleasantly while away the 
hours. 

Always, however, whatever the undertaking, you 
should be guided by the rules for rest and exercise set 
forth in Lesson IX. 

4. After all, perhaps you require a change of scene 
or environment, or both. Frequent changes of residence 
are rarely called for, and are often decidedly harmful ; 
yet sometimes a change is very much needed. If you are 
not in harmony with those around you; or if for any 
reason you have become so out of tune with the old 
surroundings that you are living in a continual whirlpool 
of dissatisfaction and discontent, the likelihood is large 
that a change will prove of benefit. 

Before definitely deciding the point, however, it is 
advisable for you to read Lesson XII, giving special 
attention to the question of the advisability of making 
a change of locality, noting carefully the rules for 
making the journey, and taking to heart the warning 
against the wanderlust. 

Then, too, do not forget that it may be unnecessary to 
make a long journey. For the present purpose, it is 



420 LESSONS ON TUBERCULOSIS 

chiefly a change of scene and surroundings you require ; 
this you may find within a very short distance. It is not 
unlikely that merely changing your residence to a dif- 
ferent part of the town or the city, or merely moving 
to the country, will lend newness and attractiveness to 
the surroundings and tremendously increase your 
chances. 

5. If other means fail, and you still continue to chafe 
and fret, and to live in fear and dread, it may be per- 
missible for you to increase your liberties slightly — to 
relax a little in your observance of the rest schedule. 
In this way, you will hope that at the expense of a little 
physical rest you will gain more than enough mental 
rest to pay for the sacrifice. Therefore you will increase 
your allowance of exercise only as much as necessary 
to achieve this purpose, and in no case will you deviate 
markedly from the rest schedule you have previously 
worked out for yourself according to the directions given 
in Lesson IX. 

In extending your allowance, there is one thing in 
particular to guard against. Often, the more liberties 
one allows oneself, the more one wants. So, before 
increasing your allowance at all, gird on your mental 
armor and steel yourself against yielding to any tempta- 
tion of this nature that may later arise. 

How Others Have Come Back 

When you are so deep in the dumps that you are 
convinced you are down and out for good, just stop 
a few moments and remind yourself of those who at 
one time were in as serious a condition, or perhaps even 
worse than you, but who kept on trying till they finally 
won back. 

For example, here is the case of a young man whose 
health failed while he was yet in college : 



WHEN "BLUE" DAYS COME 421 

On discovering that he was losing his health, immedi- 
ately he set about redeeming this precious asset, but, 
as is so often true, his early efforts were for the greater 
part in the wrong direction. His condition varied up 
and down — each time going down a little farther than 
it came up — the net result being that two years later he 
awakened to the realization that his health was in a most 
precarious state. Having harbored the mistaken idea 
that he must not allow himself to become bedfast, lest, 
as he thought, he would never get up again, he had 
persistently forced himself to stay on his feet day after 
day and month after month. Now, however, he had 
become so weak that it was impossible for him to remain 
up and about any longer, so he was compelled to go to 
bed. 

Fortunately, about this time the young man learned 
that rest was one of the most important items necessary 
for recovery. This knowledge altered the whole aspect 
of the matter, so he now became a philosopher, and 
resigned himself to wait patiently while Nature did her 
work. For many, many months the fever continued to 
rage, and his already frail body wasted away to a mere 
shadow. Finally, he grew so weak that he could not 
turn his head on the pillow, nor even change the position 
of his feet or hands, unassisted. Yet he never entirely 
gave up hope. 

After he had been in bed for eight months, on top of 
all the other difficulties there came a series of large 
hemorrhages, which served to sap almost the last ounce 
of his flickering vitality. He became unconscious, and at 
one time even his physician felt that his patient could 
not live ten minutes. Nevertheless, a faint spark of 
life remained. For weeks the young man lingered on 
the edge, while the weight of a feather would have turned 
the scales. Then slowly he began to rally. One morning 



422 LESSONS ON TUBERCULOSIS 

he opened his eyes, looked round and said, "Doctor, 
I'm better to-day; I feel that I am going to get well." 

The turning point had come. From then on, it was a 
long slow battle. The gain was steady and progressive, 
but very, very slow. 

For two years after the first improvement was noticed, 
it was necessary for him to remain abed. All this time 
he was regaining strength and weight, but the loss had 
been so great that many months were required to 
replace it. 

During the third year of convalescence, he contented 
himself to remain in bed nine-tenths of the time, altho 
(when idle) he felt well, and to casual inspection, 
appeared well. Very gradually, thereafter, he began to 
get out a little* more, and to season himself by taking 
regular, progressively increased walks. 

So his progress continued, until to-day, seven years 
after his original breakdown, he is a specimen of robust 
manhood, happy in the enjoyment of abounding health 
and in the ability to earn his livelihood. 

Another Remarkable Recovery. Now we come to 
the case of a young lady stenographer, wholly dependent 
on her own labors for her income. Under the continual 
strain of long hours of hard work, at the age of twenty- 
four she found that her health was beginning to break. 
Altho she thought she was merely "run down," she well 
knew that she needed a prolonged rest, but saw no chance 
of obtaining it. So she comprest her lips and held up 
her head and continued at work, even tho she felt like 
dropping. For six long months — months that seemed 
years — she kept faithfully and regularly at work. 

Suddenly one day she collapsed in the office, and came 
to realize that she must cease her labors, no matter 
what happened. She resigned her position and, after 
due reflection, made up her mind to stretch her small 



WHEN "BLUE" DAYS COME 423 

fund of savings to the utmost. She stopt work at the 
office, but failed to put a check on the activities of her 
brain, which continued to work overtime, ever seeking 
the way to make the dollar go farther. She lay down 
during part of each day, but skimped on the actual 
necessities; hoping meanwhile that the day when she 
could resume her duties would soon come. 

It was not long till her meager resources were com- 
pletely exhausted. She had recuperated somewhat, but 
the gain was not great. For, tho her body had rested 
to a certain extent, her brain had worked all the harder. 
This, with the lack of proper food, had hindered her 
progress materially. 

Still, tho she knew she was far from fit for work, she 
must live somehow. 

Her former employer was glad to have her back, so 
she returned to the office and took up the old routine 
grind. Tho she soon found herself slipping week by 
week, she stuck to the job, until one day she was seized 
with a burning fever; at the same time her cough 
suddenly became much worse. In a few days her 
physician informed her that she was suffering from 
'' - galloping consumption. ' ' 

Not long afterward, the young lady wisely put away 
all false pride, and allowed herself to be taken to a free 
tuberculosis sanatorium. 

Here, despite the change, she continued to sink, and 
it was not long till she grew so despondent as to give 
up all hope of surviving. She yearned to die and have it 
over with. For a time it seemed as if this wish was 
certain to be fulfilled. Her condition grew worse and 
worse : now the fever was up four to seven degrees every 
day ; the cough was very frequent and often agonizingly 
severe, the expectoration very profuse ; her breath came 
in short gasps, each one of which seemed as if it would 



424 LESSONS ON TUBERCULOSIS 

be her last. Widely through both lungs the disease 
spread like wildfire, while the thread of life grew thinner 
and thinner. 

At last, however, just when the ravages of the plague 
had become so extreme that it seemed there was nothing 
left of the frail, feeble body, the fire died down and 
burned itself out. 

After this, month after month, slowly but surely 
strength and cheer were regained, till at the end of 
two years she seemed even stronger and better than 
before her illness. She was exceedingly happy and felt 
fine, but was not yet well. 

Nevertheless, having learned how to take care of her- 
self, the young lady felt safe in again taking up her 
usual work. This she did, cautiously ; meanwhile making 
the most of all time off, for adding to her store of 
strength and energy. She continued to gain, and, as she 
gained in health, she climbed higher and higher on the 
ladder of success, until, at this writing, ten years after 
first being forced to stop work, any business day she 
may be found seated at her desk, smilingly greeting the 
patrons of the firm, in which she is now a partner. 

Instance after instance of this nature could be cited, 
but the two cases just related will suffice to show that 
in the darkest moments of all there is always room 
for hope. Courageously keep on, and you, too, may be 
overjoyed to find yourself emerging from the dark depths 
of despair into the ever brightening sunlight of hope, 
and from mere hope into the actual attainment of your 
rightful heritage of health and happiness. 



LESSON XV 

SPECIAL METHODS OF TREATMENT AND 
SURGICAL MEASURES 

Patients are usually anxious to inform themselves 
concerning the various remedies and remedial measures 
useful in tuberculosis, so an effort will now be made 
to make note of the chief remedies and special modes 
of treatment in use to-day, with occasional remarks on 
their basis of action and other points of interest. Because 
the tuberculin treatment is perhaps the most widely 
heralded of the special methods, it will be the first 
considered; but preliminary to estimating the pros and 
cons of tuberculin, a few moments may advantageously 
be given to discussing a topic that will make clearer the 
how and why of its action. This topic is — 

Active Contrasted with Passive Immunity 

When for any reason an individual becomes extraordi- 
narily resistant to a disease, he is said to have acquired 
a greater or less immunity to the particular ailment 
under consideration. Various methods have been em- 
ployed to strengthen the normal resistance of the body 
to disease. For the present purpose these methods may 
be classified as pertaining to (1) active immunity, and 
(2) passive immunity. 

1. Active Immunity. If one is attacked by an 
acute disease, such as measles, after recovery one is 
unlikely to again " catch" the same disease. This freedom 
from liability — which is of course not absolute — is 
termed active immunity. Similarly, vaccination for the 

425 



426 LESSONS ON TUBERCULOSIS 

prevention of smallpox induces an active immunity 
against this disease. Likewise, a greater or less resis- 
tance (immunity) to various diseases may be induced 
in animals by inoculating them with at first small, then 
larger, progressively increasing doses, of the germs or 
poisons responsible for the disease in question. Immunity 
induced in any one of these ways is spoken of as active 
because it is built up in the individual person or animal, 
ag the case may be, that harbors the disease-producing 
germs or poisons. 

2. Passive Immunity. Now suppose that an animal 
has been inoculated with proper-sized, gradually increas- 
ing doses of a particular variety of germ, or toxin (the 
poison produced by or derived from a disease germ) 
until it has developed a high resistance to this special 
variety of germ or poison. Suppose further, that at 
this stage of the experiment blood is drawn from the 
animal, and the liquid portion of the blood — the serum — 
is injected into a human being ill of the identical malady 
— assuming further that the carrying out of these steps 
results in curing the sick person through the transfer 
to him of protective or immune substances previously 
formed in the animal's body. The protective power 
received passively in this manner is called passive immu- 
nity, and it is precisely in this way that diphtheria 
antitoxin (anti-diphtheritic serum) which has revolu- 
tionized the treatment of this one-time dread disease 
and has saved thousands of lives, is produced. 

Offhand one would say that of the two methods, the 
safer and surer must be passive immunization. Certainly 
this would seem to be true in the event that the use of 
one or the other of the two procedures is under consider- 
ation for employment with hope of benefiting a person 
who is already ill. That is — when the method is to be 
used for its curative effect, and not as a preventive. 



SPECIAL METHODS OF TREATMENT 427 

Yet, strange to add, passive immunization has so far 
proven notably successful in only a very limited number 
of diseases. (One reason is that in some diseases the 
antidotal or immune substances remain chiefly in the 
fixt tissues of the body, and therefore cannot be trans- 
ferred to the human being in effective amount by means 
of the blood.) Moreover, oddly enough, investigations 
have established the fact that in certain diseases it is 
possible to raise the resistance of the individual to a 
disease with which he is at the time afflicted ; that is to 
say, to a limited or moderate extent it has proven 
practicable to induce active immunity in the body of 
the person who is at the time ill. This means, as explained 
in Lessons IV and VIII, that Nature sometimes has 
power to work harder and more efficiently in over- 
throwing the ills under which we labor, if only she is 
properly stimulated to do so. She has the energy, but 
it is dormant, and an effective outside stimulus is 
required to transform the idle potential force into actual 
kinetic, antidotal or germicidal power. Once Nature's 
energies are fully aroused, and kept continuously 
aroused, she herself goes ahead and completes the healing 
and cure. 

Tuberculin 

Tuberculin, originated in 1890 by Robert Koch, the 
discoverer of the tubercle bacillus, is an extract prepared 
from dead tubercle germs.* The basis for the use of 
tuberculin is as follows : — 

In carefully chosen cases of tuberculosis, when Nature 
fails to bring fully into play her power for healing, by 
arousing her dormant energies the injection of appro- 
priate doses of tuberculin serves a useful purpose. If 



*There are now a wide variety of tuberculins. They are 
all similar yet slightly different, and some of the newer 
varieties can be safely used in cases for which the old or 
original tuberculin was altogether unsuited. 



428 LESSONS ON TUBERCULOSIS 

the doses and the intervals between doses are correctly 
estimated, following each dose there is brought about a 
congestion or mild inflammation in and around the focus 
of tuberculosis. Now, if it is understood that early in 
the evolution of the tubercles the blood supply to the 
diseased area is greatly reduced, and that the later 
development of scars (which by limiting the escape of 
poisons into the general circulation and by walling off 
the tubercles helps to localize the disease) further inter- 
feres with the circulation of blood in the tubercles, it 
is readily seen, how, following each dose of tuberculin, 
the influx of fresh blood, bringing a new army of cor- 
puscles to combat the germs, with reparative and heal- 
ing material, will prove of benefit. 

That the good results of the tuberculin treatment are 
derived chiefly in the manner just described (that is 
to say, through a local stimulation in the focus of tuber- 
culosis) there is no doubt, but some observers hold that 
tuberculin is also materially helpful in quite a different 
way. According to this view, the cells and tissues of 
the body distant from the disease focus are capable of 
material assistance in the fight against the germs if only 
a suitable stimulus is brought to bear upon them. So 
if tuberculin is injected into these healthier parts of 
the anatomy, the tissues are stimulated to manufacture 
antidotal or anti-substances to neutralize or destroy the 
injected tuberculin. Here an interesting law of Nature 
comes into play : Once thoroughly awakened, Nature is 
inclined to overdo things. In the present instance this 
takes the form of an over-production of the anti — or 
immune — substances (more than enough to counteract or 
destroy the dose of tuberculin just administered), and 
the surplus of anti-substances — sometimes termed anti- 
bodies — then circulates in the blood stream, ultimately 
reaching the lungs, where the anti-substances come in 



SPECIAL METHODS OF TREATMENT 429 

. contact with, and neutralize or destroy the virulent 
poisons and live germs of tuberculosis. 

In administering tuberculin, the treatment is in- 
augurated with small dosage, and when the maximum 
benefit has been obtained from each dose, by repeating 
or increasing the dose at judicious intervals, the aim 
is to keep Nature constantly on the job, with her energies 
working against the disease at the highest pitch con- 
sistent with safety. 

Value of Tuberculin. Unfortunately, tuberculin has 
not accomplished nearly as much as its originator hoped 
for, yet in competent hands, administered in carefully 
selected cases, it adds to the chances of recovery and is 
worthy of use. On the other hand, given indiscriminately 
to all patients, or by those unfamiliar with its use, 
tuberculin can do harm. In brief, if one is in the hands 
of an expert who deems the case suitable for tuberculin, 
one may permit the injections without fear, with perfect 
confidence, and with reasonable hope of benefit, provided 
this does not make necessary the slighting of one of 
the more essential items. 

This means that altho tuberculin is valuable, it is 
worth less than rest, wholesome food, fresh air, a con- 
genial environment, competent medical supervision, suf- 
ficient time, and a favorable climate. On the other hand, 
if one can have all of these things, with tuberculin in 
addition if the case is suitable, so much the better. Again, 
if it is impossible under any and all circumstances to 
obtain sufficient rest or the like, and if the case is appro- 
priate,* tuberculin will improve the outlook for victory. 

*Many have the fixed belief that tuberculin should never 
be used in the presence of fever. The real guide is the respon- 
sive power of the body, which can be estimated only by a care- 
ful study of all factors in the case. Many patients having* 
low, moderate or high fever, or who are, on the contrary, 
entirely free of fever, are not suitable subjects for treatment 
with the older varieties of tuberculin. Other patients with- 
out fever, or with but mild fever, can be treated successfully, 
and some of the newer preparations of tuberculin nature 
can be safely used in cases with considerable fever. 



430 LESSONS ON TUBERCULOSIS 

Vaccines 

In principle similar to tuberculin, vaccines have been 
prepared against the " mixed' ' or secondary infections 
so common in tuberculosis, for the prevention and allevi- 
ation of " colds,' ' etc. If the vaccine is prepared from 
germs cultivated from the patient's own sputum or 
other discharge, it is called an "autogenous" vaccine. 
On the other hand, if it is made from germs obtained 
from other sources, it is spoken of as a "stock" vaccine. 
Each variety has its drawbacks : each has its good points. 
Given with discernment, vaccines are useful additions 
to other treatments in certain cases. 

Remedies fob Passive Immunization 

Among remedies designed to confer passive resistance 
to tuberculosis, a preparation known as "I-K" (meaning 
immune bodies) has enjoyed more or less favor for a 
number of years. In the production of I-K, the aim 
is first to actively immunize an animal both against 
tuberculosis and the germs commonly responsible for 
mixed infection (a definition of active immunity may 
be found on a previous page) ; the animal is then bled 
and an extract prepared from its blood corpuscles — this 
extract constituting I-K. It is the belief of the originator 
of I-K, Dr. Carl Spengler of Davos, Switzerland, that 
the corpuscles of the blood are of more importance as 
sources of protective substances than is the liquid 
portion of the blood, the serum. 

Speaking broadly, I-K may be said to be safer than 
tuberculin. It can also be used in certain cases for 
which tuberculin is unsuitable. On the other hand, it 
is the consensus of opinion among physicians who have 
had a large experience with both remedies, that for 
patients to whom either remedy may safely be given, 
tuberculin has the most value to offer. 



SPECIAL METHODS OF TREATMENT 431 

Other preparations, the object of which is to transfer 
immunity from the animal to man have been developed, 
tho they have not been used extensively in this country. 
In general, so far as benefit is concerned, they are com- 
parable to I-K. 

The X-ray and Radium 

Since the announcement to the world in the last 
decade of the nineteenth century of the discovery of the 
Roentgen or X-ray, it has been hoped that a way would 
be found to turn this wonderful agency to account in 
eradicating tuberculosis. 

Up to the present this hope has been fulfilled only in 
part. In tuberculosis of the lymph glands (scrofula) 
and of the bones and joints (the " white swelling" of 
former years — in two of its relatively frequent locations 
termed Potts' disease and hip-joint disease), as well as 
in other localized forms of tuberculosis, the X-ray has 
in many instances proven of decided benefit; as it is 
learned how to apply its healing rays to advantage it is 
probable that it will become more and more useful in 
such cases. 

As tuberculosis of the lungs makes up the great bulk 
of tuberculosis cases, it was for its effect upon this form 
of the disease that the hopes of thousands soon focused 
upon the newly discovered ray. This hope has not yet 
been satisfied, for altho here and there a physician has 
reported success with the X-ray in pulmonary tubercu- 
losis, and many investigations are being faithfully pros- 
ecuted, with some apparent advance, for the present 
the Scotch verdict, "not proven," must still apply. 

Radium. With the discovery of radium, many eyes 
turned to it as the long-hoped-for charm against the 
white plague. Tet up to this writing this wonder-element 
has failed in tuberculosis to duplicate its accomplish- 



432 LESSONS ON TUBERCULOSIS 

ments in certain other diseases. Radium is now applied 
locally, taken internally and given by the needle directly 
into the blood stream, and has been more or less helpful 
in a wide variety of ailments. In tuberculosis it is 
sometimes of service in relieving pleurisy and other 
painful conditions, and has a general tonic effect of 
value. It has also wrought benefit in tuberculosis of the 
lymph glands and skin — but beyond this it has so far 
wrought little of benefit. 

Artificial Light Treatment 

In Lesson XI emphasis has been placed on the value 
of sunlight, if properly employed. Among the drawbacks 
of this form of treatment have been the inconstancy of 
the sun in many localities, the intolerable heat in others 
(whereas the cold rays are really the most valuable), and 
the like. Lamps for producing light artificially to over- 
come the objectionable features of sunlight and with 
other features of advantage, have been devised. Among 
these light-producing agencies, the so-called Alpine Sun 
Lamp is perhaps most widely used. In this lamp, the 
passing of an electric current through mercury vapor in 
a vacuum generates an intensely bright light which is 
emitted through a burner of transparent fused quartz. 
The light produced in this manner is very similar to sun- 
light, without, however, its intense heat, and is extraor- 
dinarily rich in the health-giving violet and ultra- 
violet rays. By this means, an intensified light can be 
produced at will, and the light treatment carried out 
regularly and consistently in any locality without regard 
to weather fluctuations; the dosage can be more accu- 
rately controlled, and less time need be allotted to each 
seance than when the sun's rays are used. Light (both 
natural and artificial) is a useful adjunct in the treat- 
ment of certain cases of lung tuberculosis, but has an 






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SPECIAL METHODS OF TEEATMENT 433 

even larger field of usefulness in the treatment of tuber- 
culosis of the peritoneum, of the bones, joints and glands, 
and other so-called local forms of the disease. 

Treatment with Animal Products 

Since it was learned years ago that children who 
were victims of cretinism — a form of physical and mental 
stunting, sometimes amounting to actual idiocy, associ- 
ated with the absence or maldevelopment of the thyroid 
gland in the neck — can often be rescued from a life of 
helpless dependency and transformed into real human be- 
ings, merely by feeding them the thyroid glands from 
sheep or other animals, the principle of treating the sick 
with products derived from animals has been used suc- 
cessfully in other diseases. Preparations of this nature 
have also been employed in tuberculosis for various rea- 
sons. As regards the results obtained, the limits of 
space permit merely the bare statement that certain an- 
imal products are now available which, given for definite 
objects according to individual circumstances, add their 
quota toward success. As this field is explored more 
and more widely, it is probable that remedies of increas- 
ing value will be developed. 

The Russell Dietary Treatment 

A mode of treatment that can be made use of in the 
home and which is worthy of trial in certain cases is the 
so-called Russell dietary treatment. In Lesson IV was 
explained how in the healing of tuberculosis Nature 
deposits litne salts in the form of a cement-like material 
in and around the tubercles. In order to make available 
an abundant supply of lime for this and other purposes, 
the Russell method aims to furnish a large amount of 
lime-carrying food and to assist in the digestion of the 
food and in the assimilation of the lime. 

28 



434 LESSONS ON TUBERCULOSIS 

It has long been known that milk and eggs contain an 
extraordinarily large per cent of lime, and this is one 
of the reasons why these two staple food articles have 
for years held a high place in dietaries for the sick. One 
phase of the Russell plan of treatment consists in the 
eating of certain definite amounts of milk and eggs, to 
which dilute hydrochloric acid (which is a normal con- 
stituent of the stomach's digestive fluid) has been added 
for the purpose of assisting the process of digestion and 
to facilitate the assimilation of the lime contained in 
these foods. To make doubly sure that an adequate 
quantity of lime is available, this is supplemented by 
the eating of a special lime food prepared from fresh, 
uncooked chicken bones. The third part of the treat- 
ment consists in the taking of an emulsion of easily 
digested mixed fats. The function of this emulsion is 
merely to provide in an attractive, convenient form a 
certain amount of concentrated fat food. The pulmonary 
invalid is often inclined to partake but sparingly of fatty 
articles of food, whereas on the average he actually 
requires a somewhat larger per cent of fat than a well 
person. This fat is necessary in part to furnish reserve 
energy, but also because fat seems to favor the deposition 
of lime in and around the tubercles. 

Rules for Taking the Russell Treatment. (1) Thor- 
oughly beat two raw eggs, then mix with a quart of fresh 
milk and beat again. Add 240 drops of chemically pure 
dilute hydrochloric (muriatic) acid, and once more beat 
or stir well. The acid will thicken or clot the milk to a 
greater or less extent — this being the first stage of its 
digestion. Immediately on the addition of the acid the 
mixture is ready for drinking, but that portion which 
is not drunk at once should be kept well cooled until 
consumed. One glass of the mixture is to be taken imme- 
diately after each meal and a second glassful is taken 



SPECIAL METHODS OF TREATMENT 435 

one-half hour after the mid-day meal. Each time just 
before drinking the mixture should be stirred. 

(2) One-fourth of a level teaspoonful of the Russell 
prepared lime food (a palatable jelly-like preparation 
obtainable of the druggist) is taken twice daily, with or 
immediately after breakfast and the evening meal. Prob- 
ably the easiest way to take the lime food is to place it 
upon the tongue and swallow with a little water, altho 
some prefer to take it spread upon bread. 

(3) If one has lost much weight and fails to gain on a 
dietary of ordinary amount, the emulsion of mixed fats 
may be added to the above regimen. In this event one 
tablespoonf ul of the Russell emulsion of mixed fats is 
taken in a full glass of hot water one and one-half hours 
after breakfast and the evening meal. If after a reason- 
able length of time a gain in weight fails to materialize, 
and provided further that the emulsion is well tolerated, 
it will probably prove helpful to cautiously increase the 
dose every few days by a teaspoonful or a tablespoonful, 
in some case until four tablespoonfuls are taken twice 
daily. 

Notes and Suggestions. When preparing the milk- 
egg mixture the first time the approximate bulk of the 
240 drops of acid may be estimated, so that thereafter 
it will be unnecessary to pour out the acid drop by drop, 
as the variation of a few drops one way or the other is 
unimportant. The ordinary teaspoon holds abotft eighty 
drops. 

It is sometimes advantageous to take an extra pint or 
quart of milk (either with or without the addition of one 
or two eggs to the pint or quart of milk, respectively) 
with which acid has been mixed in the proportion just 
indicated. This extra nourishment may be taken at the 
time that appears most suitable in the given case. 

Some persons are habitually or periodically troubled 



436 LESSONS ON TUBERCULOSIS 

with an oversupply of the hydrochloric acid in the 
stomach juice, and in this event to add hydrochloric 
acid to the food will only add insult to injury. To 
guard against this mishap, when the patient has been 
troubled with burning in the stomach, or if any other 
symptom seems to point to excessive acidity, the milk- 
egg-acid mixture should be taken with great caution, and 
a smaller quantity of acid should be used during the first 
few days. If the stomach symptoms become aggravated, 
after a fair trial this part of the treatment had best be 
abandoned. On the other hand if all goes well the amount 
of acid may be increased to the regular amount. 

Finally, it should be borne in mind that in large 
part the Russell method is, after all, a special method 
for forced feeding. Altho forced feeding is sometimes 
worth while, it should not be forgotten that it has serious 
drawbacks and dangers (see Lesson IX). Remember, too, 
that whatever the method of forced feeding employed 
it is highly essential that efficient bowel evacuations be 
maintained. So when making use of Russell's method 
strict attention to this point will obviate much difficulty. 
During the course of treatment it is often necessary to 
take a mild laxative nightly. For this purpose, cascara, 
compound licorice powder or one or two A.B.S. and C. 
tablets are quite reliable. In addition it is in many 
cases a good plan to take every week or ten days a good- 
sized dose of castor oil or its equivalent. 

Other Remedies and Outlook for Future Advance 

Throughout the world thousands of zealous workers 
are conducting investigations from a multitude of angles 
in the continual search for a remedy of sovereign value. 
Tho no specific remedy of high potency has been brought 
forward, a number of non-specific but nevertheless valu- 
able remedies, have been produced, and the prospects 



SPECIAL METHODS OF TREATMENT 437 

are bright for the development of better remedies. These 
non-specific remedies are derived from a wide variety 
of sources, but the limit of space prevents describing 
them here. Suffice it to say that they come from the 
vegetable, mineral and animal kingdoms, and that in 
using them the physician's main purpose is to assist 
in strengthening the bodily defenses against the germs. 
In one case, or for a certain period, one preparation may 
be administered to increase the number of red corpuscles 
in the blood or to improve their quality, another may 
be used for its effect on the white corpuscles, another 
to supply healing material in larger quantity, through 
the use of others the physician endeavors to increase the 
germicidal power of the blood, others are given for still 
different purposes, but the chief aim in nearly all in- 
stances is to supplement or reinforce Nature's efforts 
in one direction or another. 

A promising line of exploration is the realm of 
chemical treatment. The object of the chemical treatment 
is to develop a remedy having a special affinity for the 
germs of tuberculosis or for tuberculosis tissue, or both, 
so that it will either kill the germs directly or else 
stimulate healing in the area of disease without injury 
to the sound tissues of the body. As an example of the 
way in which the investigations are prosecuted, the fol- 
lowing instance may be cited : — 

Several groups of scientists are using various kinds 
of dyes in their experiments. The dyes are first adminis- 
tered to tuberculous animals; then, by examining the 
bodies of the animals after death, the microscope will 
readily detect whether or not the particular dye under 
consideration has a strong affinity for the tuberculous 
tissue or germs. A number of dyes have been found or 
originated having a selective action of this nature. So, 
too, there are numerous germicides which will destroy 



438 LESSONS ON TUBERCULOSIS 

the tubercle bacilli outside the body. Thus far, however, 
no dye has been discovered or produced in which the 
selective affinity (so necessary to avoid harming the 
individual) and the germicidal or healing effect are both 
marked, tho some encouraging results in this direction 
have been achieved. 

Research has opened up many other interesting ave- 
nues of hope, and any day may see the efforts of one or 
more of the many earnest research workers, who are con- 
secrating their lives to this cause, crowned with the glory 
of achievement. It is probable, however, that the methods 
now used successfully, which are in the main natural 
methods, will always or at least for many years remain 
unsuperseded as the sound foundation on which adjunct 
methods may be added. The remedial agency or agencies 
of the future will probably be supplementary to those 
of the present. They will not be sure-cures nor magic 
keys to health, but will help save many more lives and 
will shorten the time given to recovery. 

In concluding this little talk on remedies for tuber- 
culosis, let it be made clear that while there can hardly 
be said to be in existence a single medicament or meas- 
ure for use in all cases, yet the use of the appropriate 
remedy at the opportune time may materially influence 
the progress of the case, and even turn total failure 
into success. The physician who uses all means to safe- 
guard the interests of his patient is continually on the 
watch for small changes in his condition, so that he 
may meet them promptly by modifying or making suit- 
able changes in the treatment. 

Surgical Procedures 

Instances in which the knife is worthy of use in 
tuberculosis of the lungs are far between. When a 
definite abscess of the lungs is present it is sometimes 



SPECIAL METHODS OF TREATMENT 439 

advisable to open and drain it (altho certain cases of 
lung abscess have been cured by the method of treatment 
known as artificial pneumothorax — to be described in a 
moment). Under very exceptional circumstances a drain- 
age operation may be resorted to for the purpose of 
facilitating healing of a more ordinary cavity, if super- 
ficially situated. Again, in rare instances, the question 
of the removal of one or more ribs, for the purpose 
of allowing the chest wall to fall inward, so that the lung 
will collapse and be given rest (or other operations to 
aid lung collapse) may be considered. Similarly, an 
attempt to cut away part of the diseased lung may be 
taken under advisement. So, too, in the event of certain 
complications, for example, the accumulation of pus in 
the pleural space between the lung and chest wall — 
empyema — some procedure for securing thorough drain- 
age may be warranted. When, however, the accumulated 
material resembles, yet is not true pus, more conservative 
methods are usually in order. On the whole there is only 
a small field for strictly surgical procedures within the 
chest. Within the last decade methods for operating 
in air-tight cabinets under air-pressure conditions that 
lessen the danger from sudden collapse of the lung dur- 
ing operations have been devised, but even with this 
safeguard, surgery of the lungs has not achieved a great 
deal. 

The Pneumothorax, "Gas" or Compression 
Treatment 

There is, however, one method of treatment, mechani- 
cal in its nature, sometimes classified as a surgical pro- 
cedure, which constitutes a notable addition to the 
weapons useful against tuberculosis. This, the pneumo- 
thorax or compression treatment, sometimes spoken of 
as the "gas" treatment, has now been employed suffi- 



440 LESSONS ON TUBERCULOSIS 

ciently widely during a number of years to conclusively 
establish its value. 

The word, pneumothorax, signifies the presence of air 
or gas in the thorax or chest, it being further understood 
that the gas is present in the pleural space — that is, 
between the lung and the chest wall. It has long been 
known that spontaneous pneumothorax occurs in certain 
cases of tuberculosis (usually as the result of the rupture 
of the wall of a superficially situated cavity, allowing 
the air to escape from the lung into the pleural space) . 
The sudden escaping of air in this accidental manner is 
often quite a shock to the patient, and has other dangers, 
but nevertheless it was noted in certain instances that 
definite improvement in the condition of the patient 
dated from this complication. The sequence of these 
observations was that a way was sought to bring about 
pneumothorax artificially in such a manner as-would 
secure its benefits and at the same time avoid the dangers 
associated with its onset under ordinary or natural 
circumstances. 

The purpose of the treatment is to lessen the expansion 
and contraction of the lung, and, degree by degree, a 
little at a time, to compress it more and more with a 
cushion of gas until, in some instances, it is completely 
collapsed. Thus, the organ is given rest, poisonous secre- 
tions are squeezed out so that absorption of toxic material 
is diminished, and the walls of cavities pressed together 
— all of which favors healing. 

The gas (or more recently, air) is allowed to enter 
the chest very slowly through a hollow needle inserted 
into the pleural space. Only a very small quantity is 
introduced at the first injection, which is repeated in a 
day or two. During subsequent treatments a slightly 
larger quantity of air may be injected, tho speaking 
broadly, the best results are obtained by the injection 



SPECIAL METHODS OF TREATMENT 441 

of relatively small quantities at comparatively short 
intervals. 

At first a considerable part of the gas disappears (is 
absorbed) between injections, but as the lung is com- 
prest more and more the gas is absorbed correspond- 
ingly more slowly, so that as time proceeds the injections 
can be spaced farther and farther apart. Altho good 
results have sometimes been achieved in shorter periods, 
it is ordinarily provident to maintain the lung collapse 
for from one to two years — or for a longer time. 

Cases Suitable. The ideal case for pneumothorax is 
one in which one lung only is affected, with but a few 
if any pleural adhesions present (which latter may 
so bind the lung to the chest wall as to make difficult or 
impossible the introduction of sufficient gas to be of 
service), and with the heart in good condition. It is 
obvious that this form of treatment makes it necessary 
for the opposite lung to perform extra duty and puts 
an undue burden upon the heart, so it is imperative 
that these organs be able to stand up under this un- 
wonted strain. As a matter of fact, the ideal conditions 
just mentioned are seldom found except in very early 
tuberculosis, and inasmuch as excellent results are ob- 
tainable in early tuberculosis by the more ordinary 
methods, it is questionable whether or not this special 
treatment should be undertaken in this class of cases.* 

Fortunately, however, with the technique as now de- 
veloped, thereby the lung compression is brought about 
very, very gradually, it has proven practicable to use 
the method successfully even tho the opposite lung is 



* In the present state of our knowledge, save when other 
means have failed, or under other extraordinary circumstances, 
I personally am opposed to the induction of pneumothorax in 
early cases unless the patient desires it with the distinct under- 
standing" that its utility in this stage of the disease, above and 
beyond other measures, is not thoroughly established. How- 
ever, it is possible that time may prove that a larger per- 
centage of g-ood results will be obtained by employing: pneu- 
mothorax early in the disease. 



442 LESSONS ON TUBERCULOSIS 

affected to some extent, provided the heart is fairly 
sound and the pleural adhesions or bands not very dense 
or extensive.* 

In conclusion it may be said that altho the actual intro- 
duction of the gas is simple, and in skilled hands, from a 
practical standpoint, safe, yet the procedure is not to 
be looked up as altogether free from danger, nor to be 
haphazardly applied. On the other hand, with care in 
choosing the case the danger is small, and the results 
often remarkable and most gratifying. The most impor- 
tant result of the treatment is that it unquestionably 
saves lives that would otherwise be lost ; most gratifying 
of all, it saves certain patients with far advanced tuber- 
culosis, to whom, steadily failing despite all ordinary 
measures, we formerly had nothing to offer. Moreover, to 
a certain extent it cuts down the time that need be de- 
voted to recovery; or at any rate the patient may often 
have more freedom while reclaiming his health than he 
would otherwise be allowed. On the whole, when the 
case is suitable, the pneumothorax treatment is a most 
valuable supplement to other time-tested measures. 

Suggestions for Refractory Cases 

For those cases that do not yield to ordinary meas- 
ures, or to ordinary measures as usually applied, among 
the following suggestions may be found one or more to 
fit the necessities of the given case, and which may fill 
an important place in a winning program. 

1. Absolute Rest. The patient should remain in 



* When adhesions prevent effective collapse of the lung, 
surgery may still save the day for the patient. By painstaking 
technic, it sometimes proves practical to release the lung by 
dividing the adhesions. In other cases, the ribs overlying the 
seat of disease, may be removed in part or whole, allowing the 
chest wall to sink inward so that collapse is brought about. In 
still other instances, pieces of fatty tissue are transplanted, or 
foreign material inserted beneath the superficial structures and 
over the tuberculous area, to assist collapse. There is no ques- 
tion that many lives have been saved by these methods after 
all else has failed. 



SPECIAL METHODS OF TREATMENT 443 

bed constantly, use a bed-pan, and not get up for any 
purpose. No reading should be permitted, but the sick 
person may be read to in moderation if no bad effect 
is noted. The utmost care should be used in nursing, 
the attendant should feed the patient, and liquids should 
be taken from a feeding cup or through a drinking tube« 
Every effort should be made to keep the patient com- 
fortable, contented and cheerful. 

2. Silence. The voice should not be used, however 
little, not even whispering, for any purpose whatever. 
See Lesson IX, p. 199. 

3. Postural Rest. In order to give the worst lung 
the maximum amount of rest and quietude, the habit 
of lying on this side a greater portion of the time (turn- 
ing on the opposite side or in some other position perhaps 
only if, and when necessary to help in clearing out the 
secretions) may be cultivated. 

4. The Chest Binder. A belt or binder to fit snugly 
over the upper part of the chest (in which situation 
the tuberculosis is usually most severe) to give this part 
of the lungs relative rest, is worn constantly, or almost 
constantly, for weeks or months. The binder is con- 
veniently made of herringbone belting, and should be 
extra long so that when it is put on, the ends will over- 
lap some five inches. About five inches from one end 
elastic webbing is sewn, and to the other end buckles are 
affixed. Narrow shoulder straps to keep the binder from 
slipping downward should also be provided. Before put- 
ting on the binder, care should be taken in padding the 
arm-pit folds to prevent chafing. The belt is then loosely 
applied, after which the patient expires and holds his 
breath while the buckles are tightened sufficiently to 
restrict the movement of the chest. 

When the active tuberculosis is situated in the lower 
part of the lungs, or if the case is complicated by tuber- 



444 LESSONS ON TUBERCULOSIS 

culosis of the bowels, it is not advisable to use the belt, 
but in other refractory cases this is a well worth while 
procedure. 

5. Water Drinking for Relief of Fever. If fever 
persists, especially if it is high, and provided no con- 
traindication exists, the drinking of an extraordinary 
large quantity of water or other fluid (as described in 
Lesson X in the footnote on page 252) may prove help- 
ful. It should be understood, however, that if the fever 
is reduced in this manner, this is only controlling a 
symptom. Relief from fever may give opportunity for 
recuperation and in the long run save life, but merely 
lowering the body temperature does not eliminate the 
cause of the fever. It is therefore necessary to emphasize 
strongly that as rest was previously necessary to assist 
in providing favorable conditions for healing, rest con- 
tinued for a long period will probably be in order after 
the fever is lowered. 

6. Forced Feeding. If the patient is persistently 
losing weight and strength, provided the condition of 
the digestive and other organs permits, the quantity 
of food may be cautiously increased (see discussion of 
forced feeding and related topics in Lesson X), or, if 
thought advisable, the Russell treatment, described in 
Lesson XV, may be resorted to. 

7. Exercise on Alternate Days. If one has begun 
to exercise, and finds that slight temperature rises are 
produced, or other symptoms of merely a mild character 
persist or recur, the difficulty may perhaps be obviated 
by taking the walks only every other day or even every 
third day. In some cases it appears that the taking of 
even very short walks causes quite a little stirring up of 
the lung condition which does not quiet down before the 
next day, but if the walks are spaced farther apart tho 
still taken regularly, they may be taken not only with- 
out harm but with benefit. 



SPECIAL METHODS OF TREATMENT 445 
Bathing and Moist Applications in Tuberculosis 

How Frequently Should One Bathe? Just as some 
persons perspire more freely than others, so there is a 
great variation in the need for cleansing baths. For this 
purpose a bath once a week suffices for certain indi- 
viduals, whereas others just as urgently require a bath 
once daily. In general, a bath at least twice a week is 
desirable. The bathing should not be so frequent as to 
cause weakness, and for the same reason the bath should 
not be too long nor the water unduly hot. It is usually 
best to bathe in warm, rather than hot, water. For 
bed patients, a warm sponge bath once a day ordinarily 
answers the purpose of cleanliness satisfactorily. 

Cold Bathing. In addition to its function as a 
cleansing agent, the external application of water is often 
useful to the sick in other ways. For example, the cold 
sponge bath is refreshing and, like fresh air, serves as 
a valuable tonic, and its continual use helps materially 
to improve the functioning of each cell and organ of 
the body. Also, to a limited degree, the application of 
cold directly reduces the bodily temperature, but, con- 
trary to a rather prevalent opinion, this action is of 
minor importance even in fever cases. Given properly, 
the cold sponge bath is suitable for a large proportion 
of patients, and if the bath is administered by an atten- 
dant it may be given to patients who are still in bed. 
Remember: Unless advised to the contrary by a 
physician skilled in dealing with tuberculosis, the cold 
sponge bath (or any other form of cold bath) should not 
be taken for at least several days following the spitting 
of even a small amount of blood. 

Directions for Taking the Cold Sponge Bath. Ordi- 
narily the baths should be taken regularly once daily — as 
a rule preferably in the early morning, altho for special 



446 LESSONS ON TUBERCULOSIS 

reasons it may be advisable to take them at some other 
hour. It is well to arrange the requisites of the bath — a 
rough wash cloth, a basin of cold water, and a coarse 
towel, the night before — so that no time need be wasted 
in preliminaries during which chilling may occur and 
the zest for the bath may be lost. Immediately on arising, 
the surface of the body should be quickly sponged, mean- 
while applying gentle friction ; and at once followed by 
a brisk toweling. 

A cold feeling when the water is first applied is of 
course to be expected, but this should not last long, and 
it is essential that a reaction follow. This reaction is 
made evident by a pleasant tingling of the surface of 
the body, by the reddening and glowing of the skin, 
and by an agreeable feeling of general exhilaration, 
warmth and comfort. The shock of the cold water, the 
quick termination of the bath, and the rubbing, all con- 
tribute to this effect. For the early morning bath, taken 
for its invigorating effect, five minutes is in most cases 
amply sufficient for the whole bath ; and until the reactive 
power is accurately gaged it is a wise precaution to end 
the bath sooner than this. A bath so long in duration 
as to overstep or wear out the reactive power is dis- 
tinctly harmful. 

If there is reason to suppose that the reactive power 
is weak, it is sometimes well to take the first few baths in 
modified form. The first bath may be really an air-bath, 
consisting merely of the exposure of the skin surface 
to the cool morning air, followed by a brisk rubbing. 
The next day a very little water, barely cool, may be 
used; the following day colder water may be applied 
judiciously — and so on. A warm drink taken a few 
minutes previous to the bath will favor the development 
of the reaction. Inasmuch as a certain amount of shock — 
yet only a mild shock — is desired from the application of 



SPECIAL METHODS OF TREATMENT 447 

the water, it is not advisable to begin the sponging with 
warm water and then to lower the temperature of the 
water while the bath is being taken, but each day the 
( water may be made a little cooler and the period of 
sponging slightly lengthened. Until thoroughly accus- 
tomed to the cold water, the exposure of more than a 
small part of the body at one time should be avoided. 
Thus, one arm may be sponged, rubbed and covered, and 
the bathing continued in this manner until, part by part, 
the whole body has received the treatment. Standing 
with the feet in warm water while the cold water is 
being applied to the body is another useful help for 
those whose reactive ability is under par. Until this 
power becomes well developed, it may perhaps be ad- 
visable to bathe only the shoulders, chest and arms, later 
extending the area as one becomes more resistant to 
the cold. 

It should be understood that while some friction is 
necessary, the toweling should not be so vigorous as to 
cause violent exertion. Likewise, care should be used 
in rubbing the chest, and only very moderate force used 
in this region. If moderate rubbing leads to manifest 
shortness of breath or tires one, this part of the pro- 
cedure, at least, should be delegated to friendly assisting 
hands. 

It is ordinarily unprofitable to add any ingredient 
to the bath water, altho in some cases the addition of 
alcohol or a quantity of table salt seems to enhance the 
beneficial effect. 

If the cold bathing seems to be harmful rather than 
helpful, desist. 

For some individuals a quickly terminated sponge 
bath is a suitable ending to a warm cleansing bath. 

Cold Sponging During Fever. Cold baths are some- 
times of considerable benefit when the fever is high, but 



448 LESSONS ON TUBERCULOSIS 

even then the reduction of the fever is only one of the 
reasons for applying cold. Here again, the indirect effect 
of the bath on all parts of the body — in stimulating and 
strengthening each organ, in aiding the elimination of 
poisons through the kidneys, bowels and perspiration, 
and in promoting restful sleep— these and like influences 
constitute the principal reason for giving the bath. The 
reduction of the fever, tho a valuable effect, is accom- 
plished only to a slight or limited extent, and is in fact of 
secondary importance. 

When fever is the chief indication for using cold, 
the patient will be in bed, and it goes without saying 
that the bath should be administered by some other 
person. In general, the rules are the same as set forth 
above, but in fever cases it is often desirable to prolong 
the bath to fifteen or twenty minutes. If discretion is 
used in regulating the temperature of the water to 
suit the case in hand, in exposing only a small area 
of the body at a time, in gently rubbing the skin while 
applying the water, and as the bathing of each part is 
completed, in giving it a fairly brisk tho not too vigorous 
toweling, meantime noting the effect on the patient and 
being governed accordingly — much good may accrue 
from this simple procedure. 

A chilly feeling or slight shivering very naturally 
follows the application of cold, but if the shivering is 
very pronounced or kept up throughout the full length 
of the bath or even beyond it, especially if accompanied 
by a decided chattering of the teeth or a marked blueness 
of the lips — these are indications for cutting the bath 
short or for using more friction. After such an occur- 
rence, when administering the next bath, it will be best 
to use water that is not so cold, to lessen the duration 
of the bath, to apply less water or more friction — as 
judgment dictates. 



SPECIAL METHODS OF TREATMENT 449 

For the average case, water at average tap-water 
temperature is perhaps most suitable — at any rate for 
the first bath, or until the reactive power has been 
tested. An ice-cap or other form of cold application 
should be applied to the head when giving the cold bath 
during fever. 

If the fever is continuous, the bath may be repeated 
every three hours if thought best. 

Other Forms of Cold Baths and Applications. The 
cold shower bath, the needle bath and the cold tub-bath, 
all shock the system pretty severely, and should not be 
taken save on the advice of a physician familiar with the 
peculiarities of the given case. 

The " drip-sheet' ' bath is a useful form of bath for 
patients who are able to be up and around a little, and 
is especially valuable in relieving nervousness, restless- 
ness and insomnia. 

How to Apply the Drip Sheet. While the patient 
stands in a tub containing warm or hot water, to prevent 
chilling, a sheet just previously dipped in cold water 
is wrapt around him as quickly as possible in the follow- 
ing manner : "With the arms of the patient held upward, 
the dripping sheet is first wrapt snugly around the body 
from the arm-pits down ; then, with the arms at the sides, 
another turn is taken, so that the sheet covers the arms, 
shoulders and more or less of the neck, thus forming a 
close-fitting envelop for the body and extremities. 
Through the sheet the body is now briskly stroked and 
rubbed* and perhaps slapped with moderate force. Now 
and then water a little colder than that in which the 
sheet was dipt, is poured over the shoulders and allowed 
to run down the sheet. The act of rubbing and occasion- 
ally pouring on more water is continued for five or ten 
minutes, after which the patient is thoroughly dried and 
rubbed with a coarse towel till a warm glow and flushing 
suffuses the skin. 

29 



450 LESSONS ON TUBERCULOSIS 

In rare instances the water may be poured over the 
head also, but for the great majority this entails too 
much chance of taking cold. When this is not done, it 
is well to fasten an ice-cap on the head just before apply- 
ing the wet sheet. 

In this, as in other forms of cold bathing, the exact 
temperature of the water, the duration of the bath, the 
amount of rubbing, etc., are to be governed by the re- 
active power of the individual patient. 

The Wet Jacket. A snugly fitting jacket that comes 
up close about the neck, with holes left for the arms, is 
made of several thicknesses of old linen or flannel. Just 
before retiring the jacket is wet with cold water and 
fastened carefully in place. A dry flannel jacket, with 
edges extending an inch or more beyond those of the 
moist jacket, is then put on over the latter. Impor- 
tant: Care should be taken to see that the moist 
jacket fits tightly against the skin of the chest, and that 
its edges are well covered by the dry outside jacket. 
This is to prevent air from entering and chilling the 
patient. 

The jacket should be removed in the morning; and 
followed by a cold sponge, if customary. 

The wet jacket is ofttimes of much assistance in quiet- 
ing an irritating cough, in "taking the edge off the 
nerves,' ' and in facilitating sleep. 

The Cold Throat Compress. A cold compress applied 
snugly to the throat at night is quite efficacious in reliev- 
ing the various distressful feelings in the throat associ- 
ated frequently with pure tuberculosis of the lungs, but 
which also occur in tuberculosis of the larynx or voice- 
box; it helps to pacify an irritating cough and, again, 
offers relief in throat colds (laryngitis). The directions 
for making and applying the throat compress are sub- 
stantially the same as set down above in connection with 
the discussion of the wet jacket. 



LESSON XVI 
AND AFTERWARD 

You the Director of Your Own Future 

If you wish to insure that your restoration to health 
is to be complete and permanent, it will be necessary 
for you to continue to observe regular habits of living 
and to spare yourself all excess effort throughout life. 
This does not mean that you must become a chronic 
invalid, nor does it preclude your taking an active part 
in the ordinary affairs that make life worth living. It 
does mean, however, that you must be guided always by 
your own strength and life resources, not by what some- 
one else does who appears no stronger than you, not by 
what others tell you to do — nor by what you wish to do. 
If you will but respect these limitations* you can doubt- 
less accomplish much, and it is even possible that in 
time you will be able to assume a larger share in the 
affairs of the world than before your breakdown. 

It may be that previous to your first knowledge that 
anything was wrong with you, you had long been 
achieving merely a half-way success because you had 
been laboring under a heavy, tho unrecognized, handicap. 
Now that you are rid of this encumbrance, if you will 
merely apply to the future the lessons of living you have 
just learned, and approach the return to work gradually 



* In some cases the best result that can be obtained under 
present methods is to secure a quiescence of the disease. By 
learning 1 "how to live with tuberculosis," as someone has said, 
many in just this condition, have taken an active part in the 
things that make life worth living, and have lived to a g-ood 
old ag"e. 

451 



452 LESSONS ON TUBERCULOSIS 

by a sort of tapering-off process, it is not at all unlikely 
that there is a pleasant surprise in store for you. 

Scars Not Firmly Set for Years. In Lesson VIII has 
been explained how the cure of tuberculosis differs from 
the cure of most other diseases, and how in all cases, 
even the mildest and slightest, true healing proceeds 
slowly. It is usually several years after all symptoms 
have disappeared ere the scars become firmly cemented, 
and in many cases a certain number of the germs of 
tuberculosis remain in the lungs indefinitely. The more 
solid the scars, the more certain the imprisonment of 
these residual germs, yet it should be made clear that 
in such instances there always remains the chance of a 
renewed outbreak, should the local or general resistance 
of the body be allowed to sink below the safety level.* 

Other Organs also Require Time for Recuperation. 
Another reason for prolonged after-care is that in some 
cases of tuberculosis the functioning of organs other 
than the lungs has been seriously impaired (see especially 
Lessons IV and VIII). Hence, even tho the lungs have 
entirely healed, the reserve strength of the individual 
may still be considerably below par, and until all parts 
of the body have had time to recuperate gradually, 
caution is necessary. On the other hand, it is very 
encouraging to note that even in those cases wherein 
the disease has made its influence felt far and wide, it is 

* For this reason, the National Tuberculosis Association is 
endeavoring- to lessen the use of the word "cure" in tuberculosis — 
the term "arrestment" being" preferred. This knowledge should 
not cause discouragement, as the use of the term, arrestment, is 
really a safeguard which aims to avoid the false feeling of 
perfect security created by the employment of the term "cure," 
which has so often led to the dropping 1 back into faulty methods 
of living, with a consequent relapse. 

According to the classification of the National Association, 
even the phrase "apparently cured" is not applied until all signs 
and symptoms other than such as may be due to scars and 
other results of the disease, have been absent for two years 
under ordinary conditions of life. Let no one tell you, there- 
fore, that your lungs are again absolutely sound and that you 
are certainly cured until at least several years have elapsed. 
Understand that even then such a statement is fallible, and that 
it is the consensus of opinion among all high authorities that 
time is the only thoroughly reliable test. 



AND AFTERWARD 453 

astonishing ^how organs that have been very much 
crippled will "come back," if only given time. (Read 
also carefully the passage entitled, "Precautions for 
Certain Patients," in Lesson IX.) 

Having said this much on one side of the question, 
now a word of cheer may not come amiss. Every now 
and then an exclamation on this order is heard : l ' Oh, 
one never becomes really well after once having tubercu- 
losis ! One may improve and seem well for a while, but 
will at no time be good for much, and a new attack 
sooner or later is almost inevitable. f ' If true, this would 
be very discouraging — but let us extract the grain of 
truth from the statement, and convert it into a grain 
of wisdom and foresight — into a passport of safety for 
the future. Let us understand clearly that a relapse into 
the old ruts of living may lead to a relapse in the dis- 
ease; let us cling to the truth, on the other hand, that 
with consistent adherence to a reasonable program in 
which both work and relaxation play a part, the chance 
that another breakdown will occur is small indeed. 

Importance of Temperate Outdoor Living 

Open-Air Sleeping. Fresh air should continue to 
be one of the outstanding items in your program for 
health. At all times you should endeavor to obtain an 
abundance of fresh, pure air, spending as much time 
out of doors as possible. If your work makes it necessary 
for you to remain indoors almost constantly during the 
day, it is all the more essential that you have an open- 
air sleeping room. Let outdoor sleeping be the key-link 
in your health armor. When indoors, in addition to 
making adequate provision for admitting air fresh from 
the outside and for letting out the impure, stale air, do 
not forget that keeping the air moving and keeping its 
temperature and moisture-content properly regulated are 



454 LESSONS ON TUBERCULOSIS 

very important factors. Remember the electric fan, and 
see Lesson XI for practical hints on air-moisture and 
temperature regulation. 

"When May I Return to Work V 

In some cases the answer to this question resolves 
itself into how long one is able to refrain from work. 
In other instances, however, work which is agreeable 
and light, taken up gradually as convalescence continues, 
is a valuable health-promoter. There is such a thing, of 
course, as getting too much rest, so when one has pro- 
gressed sufficiently far there comes a time when some 
suitable employment, taken up at first merely as an 
avocation, may prove a blessing indeed. 

For those who are more or less given to brooding and 
fretting, some sort of occupation not only serves to divert 
the thoughts into more pleasant, wholesome channels, 
but, as they find themselves day by day standing once 
again more and more firmly on their own feet in a 
business way, this concrete proof that they are able to 
do something useful creates a feeling of intense satis- 
faction, and a sharpening of the interest in the delights 
of living that only those who have gone through the 
experience can fully appreciate. 

Guides to Choice of Occupation. In many instances, 
the return to one's former employment will be best, 
because one is most familiar with the work; but when 
it is desirable to exercise a choice in the selection of an 
occupation, the aim should be to choose some compara- 
tively light work, with the hours for labor minimal and 
regular. An occupation in which one finds a natural 
interest and which is enjoyed is to be given preference. 
The less worry and responsibility involved, the better. 
Other things being equal outdoor work is better than 
indoor work, but light work indoors will probably be 



AND AFTERWARD 455 

more suitable than heavy work outdoors. This is espe- 
cially true if the outdoor employment is unfitted to the 
ability or tastes of the individual. 

Mental Effort versus Physical Labor. An opinion 
is abroad that one who has passed through an attack 
of tuberculosis will as a matter of course fare better 
by taking up some calling that requires brain work 
rather than manual labor. This is a question for indi- 
vidual determination. Throughout these lessons the fact 
has been set down in different ways in several places 
that mental effort uses up energy and is a drain on the 
bodily resources and resistance, the same as physical 
effort. It is often hard to determine which of the two 
uses up the most strength. This is to a certain extent 
true all through the disease, but applies with even more 
force when one begins to take up work again. At this 
time, unless the inroads of the tuberculosis were ex- 
tremely severe, a certain amount of physical exercise is 
not only harmless but actually beneficial. So, also, a 
reasonable amount of mental activity, if so directed as 
not to tire the mind and nerves, will be helpful. Never- 
theless, it is oftem a fact that the muscles regain 
strength and vigor more rapidly than the nerves, so 
in practise it is often the case that work which requires 
merely the moderate use of the body and muscles is 
more healthful than work that entails a large amount 
of brain activity. On the whole, an occupation that 
makes necessary enough bodily activity to keep one in 
good physical trim without stretnuous or prolonged 
exertion ; which calls also for a limited amount of mental 
output, short of producing brain-fag, and without heavy 
responsibility, will perhaps prove best in the average 
case. 

At all events, unless you are accustomed to farm or 
ranch work, do not expect to find light work on a ranch. 



456 LESSONS ON TUBERCULOSIS 

True, some ranch work is easier than other ranch work, 
but it is unlikely that you will feel that such work is 
light unless you have previously done the heavier work. 

In Lesson III, under the caption ' * Choice of Occupa- 
tion,' ' you will find some other suggestions that may 
help you in forming a decision. 

How to Begin Work, If you can possibly do so, 
take up the work by degrees, and guard yourself care- 
fully against becoming overtired. It is well to put in 
only a few hours a day at first, then, as things go 
smoothly, you may gradually lengthen the time. If it 
is absolutely necessary for you to begin at once with a 
full day's work, make it a fixed rule to spend every 
free moment in the open air. If your occupation is 
a sedentary one, calling chiefly for mental activity, and 
if you do not find yourself thoroughly tired when the 
hour of freedom arrives, it will probably prove profitable, 
after a preliminary period of rest, to exercise a little in 
the open air. Ordinarily this means walking or some 
other mild undertaking for keeping the muscles and 
circulation in good condition. For some, very light 
gardening will fill the bill satisfactorily. On the other 
hand, if your work is mainly physical, it will be safest 
at first for you to spend your spare time at rest. In 
this case, on Sundays you can spend a large part, per- 
haps the whole, of the day, in bed to advantage. Only 
after it has been proven to your satisfaction that you 
are standing the work well, should you undertake further 
physical efforts or seek recreation during your leisure 
hours. 

On Taking a Vacation 

No matter how smoothly things go, do not overlook 
the question of vacation-taking. Whether you feel that 
you need it or not, endeavor to break away completely 



AND AFTERWARD 457 

from your accustomed occupation at seasonable intervals. 
Be sure, also, that you do not make work out of these 
periods, so that you lose almost as much as you gain 
by the change. Give them over to real relaxation and 
recuperation, and you will find that the increased vigor, 
energy and ability gained more than repay you. 

Importance of Regular Outdoor Exercise Provided 
Conditions are Suitable. Giving due regard to the 
restrictions on exercise set forth above, as soon as the 
circumstances in general permit, it is highly important 
that a reasonable amount of physical exercise be in- 
corporated in your daily program. Whether this consists 
of a walk of a mile or so, or some other form of exercise, 
it is important that the exercise be taken regularly — not 
by leaps and spurts. By paying consistent attention to 
this point, and by religiously observing regular hours 
for eating, sleeping, etc., many who have been forced 
to overtax themselves during working hours, have never- 
theless succeeded in preserving vigorous health. 

Amusement Suggestions 

When conditions permit, appropriate diversions and 
pastimes assist materially in making the return of health 
full and lasting. On the other hand, amusements that are 
unwisely chosen may undo all that has been accom- 
plished. 

In the first place, make it a plan to seek your amuse- 
ments in the open air. For men, enjoying the spectacle 
of the American national game is one of the safest 
pastimes, if care is used in guarding against over-use of 
the voice during exciting moments. Actual participation 
in this or other forms of violent sport is if course out 
of the question. By way of comparison, auto races are 
perhaps a little too exciting even for the looker-on, and 
the dust is another objectionable feature. As a class, 



458 LESSONS ON TUBERCULOSIS 

indoor amusements, of which the " movies' ' are perhaps 
the worst, are to be avoided. Some of the more recently 
built theaters and moving picture " palaces' ' are pro- 
vided with efficient means of ventilation, and for cooling 
or warming the air as desired, but at best indoor air is 
not as good as outside air, and as one runs the additional 
risk of picking up a cold or other respiratory infection 
from one's neighbor, visits to the movies should be few 
and far between. 

Dancing usually calls for late hours and crowd-associ- 
ation, as well as over-exertion — which last is character- 
istically unnoticed till the damage is done — and is to be 
considered strictly under the ban. 

Dangers of "Colds" and Respiratory Disorders 

How to Avoid Them and How to Care for Yourself 
at the Time. "Colds," la grippe and jpther disorders 
of the breathing apparatus sometimes serve to reawaken 
tuberculosis, so, while one should not live in a continual 
state of dread of these affections, all reasonable pre- 
cautions should be taken. For this purpose (1) you 
should avoid close association with persons who are 
suffering from colds, sore throat, tonsillitis, la grippe 
and the like. (2) If, of necessity you must be near those 
so afflicted, see that you use separate towels and dishes ; 
or make sure that the table-ware is boiled or at least 
thoroughly scalded. (3) Endeavor to keep the resisting 
power of the body always at the maximum. The last 
point constitutes a second valid reason for shunning 
indoor amusements. 

If you catch cold despite precautions, do not trust 
to chance to see you safely through, but unless it is 
absolutely impossible for you to stop work, go to bed 
and care for yourself properly at least until the height 
of the attack is passed. From then on, favor yourself 



AND AFTERWARD 459 

with a large share of rest each day until you are confi- 
dent that you are safely "out of the woods/ 9 

Importance op Periodical Medical Examination 

If at any time you notice that you are losing strength 
or weight rapidly or steadily, if the cough or expectora- 
tion starts anew or increases, if fever reappears— or, in 
a word, if you are indisposed in any way, by intercurrent 
disease or otherwise, medical advice should be promptly 
sought. Remember that relapses can occur in even the 
mildest cases, and that, as just stated, other ailments, 
particularly colds, grippe and pneumonia, are often 
responsible for a relapse. Fortunately, it is true that 
many convalescing from tuberculosis have weathered one 
or the other of these diseases without harm, yet not 
rarely a renewal of the tuberculosis follows ; so all inter- 
current conditions are to be considered serious enough 
to demand immediate treatment. 

Irrespective, however, of definite indications that 
something is wrong, you should make it a point to have 
your chest examined at frequent intervals. At first this 
should be done every three months, then every six 
months ; later once yearly may be often enough. If you 
have been under the care of a physician while redeeming 
your health (it is highly desirable that you should be), 
inasmuch as this physician is most familiar with your 
case it will usually be best to have him make the reexami- 
nation. In this way, should the trouble return it will be 
detected early and, taken in the beginning, it is probable 
that a short period of partial, or absolute rest, as re- 
quired, will set matters right. 

Do not feel that it is necessary for you to go about 
constantly hesitating at every step for fear that you 
will do something that will bring on a set-back. Do not 
feel that a set-back is almost sure to occur. If the 



460 LESSONS ON TUBERCULOSIS 

tuberculosis has been thoroughly arrested, a relapse is 
unlikely to occur if reasonable care be exercised. Yet if 
symptoms should return, one should not lose heart, for 
usually a short period of rest will suffice to clear them 
up, and things will thenceforward go smoothly. 

How Others Have Reclaimed the Maximum of 
Health and Happiness 

After all, the main point is that your future health 
and happiness largely depends on yourself. Your 
willingness to live within your limitations is the strongest 
guarantee that you will hold fast to the prize you have 
won. As you test yourself out degree by degree, as time 
passes you will be able to accomplish more and more. If 
you will put a checkrein on your ambition at the start 
and keep a firm grip on yourself, little by little you may 
extend your activities. Hold yourself in until you learn 
what you can, and what you cannot, stand, and you 
may look forward to a life of health and happiness. 
Remember that thousands before you have had experi- 
ences similar to your own, have fought the good fight, 
and "come back" to a life full to the brim with enjoy- 
ment and usefulness, and that a considerable number of 
the worlds most famous men and women, after experi- 
encing just such a breakdown in health, which they have 
fought for and won back, have wrought their deeds of 
greatest achievement. 



INDEX 



INDEX 



Aches and pains and their treat- 
ment, 364. 

Actinomycosis of lung, 89, 90. 

Adenoids take origin from lymph 
glands, 41. 

A disease of ups and downs, 112 
(See also Periodicity of symp- 
toms). 

After-care, 451-460. 

Age, of infection, 49, 100; of 
tuberculous 4i sease » 53. 

Ages, precautions necessary at all, 
54. 

Air, frequent changes from indoor 
to outdoor air harmful, 268; 
disadvantages of, 276-298; dry, 
advantages of, 297; harmful ef- 
fect of, 261. 276, 298. 

Air-moistening devices, 277. 

Air moisture, 266; bogy of, 266, 
299; some desirable, 275. 

Air movement, 264, 266. 

Air temperature, 262, 264; de- 
grees recommended, 275; mis- 
takes concerning, 274. 

Alcohol, as a medicine, 253; lowers 
resistance of body, 72. 

Altitude, effect of, 303, 304; vs. 
hemorrhage, 304; vs. nervous- 
ness, 305; virtue of, early 
recognized, 19; will it be 
necessary to remain at high?, 
305. 

A menace to every household, 16. 

Amusements, 219, 417, 457; harm 
from may not be evident, 221; 
harmful, 64, 70, 281. 

Animal products in treatment, 433. 

Answer to critics, 35. 

Apartments, care of, 78. 

Appearance of patient often mis- 
leading, 99. 

Appetite, false signals of, 240; 
fickle, 225; invigorators, 241; 
necessity for eating in absence 
of, 240; treatment of failing, 
373. 

Association, dangers of, in child- 
hood, 102; in crowds, 250; inti- 
mate, 103. 

Attitude, the sensible, 155. 



Bacilli, tubercle, absent from 
sputum, 38. 127; advisability 
of attempting to destroy all, 



463 



57; avenues of entrance for, 38; 
description of, 37; diagnosis 
may be made without finding, 
127; discovery of, 23; distribu- 
tion of, 38; dormancy of, 51, 
53; importance of dose of, 24; 
modes of entry, 38; mutation 
of, 53; varieties of, 39; 
viability of, 49. 

Bathing and moist applications, 
445-450. 

Bathing, cold, 445; frequency of, 
445. 

Battle between bacilli and Nature, 
42. 

Beans, 234; a hint on preparing, 
234; breakfast best time to 
serve, 235. 

Bed for open-air sleeping, 278. 

Beverages, 252. 

"Biliousness" and its treatment, 
372. 

Binder, abdominal, 368; chest, 
443. 

Bleeding (See Hemorrhage). 

Blood, loss of (See Hemorrhage). 

"Blue" days, 400-424. 

"Blues," a severe case of, 409; 
remedies for, 203, 411. 

Body a fortified citadel, 40. 

Bogy, of heredity, 403; of moist 
air, 266, 299. 

Bronchitis, chronic, may mean 
tuberculosis, 110. 

Building up the body, 210. 

Bungalow, individual, construc- 
tion of, 272. 

Burning sensations, treatment of, 
373 

Butter, 238. 



Cabbage, 236. 

Cases of tuberculosis, all serious, 
176; deceptive, 122; illustra- 
tive, 116-121, 122-124; that re- 
quire treatment, 99-101. 

Catarrh, a danger signal, 108, 110. 

Cause, of a peculiar state of 
affairs, 135; of tuberculosis, 37- 
54. 

Cavity, a step toward healing, 181; 
formation of, 85, 181 ; healing 
of, 181; not necessarily a 
handicap, 183; transformation 
into bronchial tube, 182; vir- 
tually outside the body, 181. 



464 



INDEX 



Cereals, 235. 

Change of residence, early belief 
in value of, 19; reasons for, 69, 
166-171, 292. 

Change, value of, 288. 

Chest binder, 443. 

Chest, changes in shape of, a re- 
sult rather than a cause, 45. 

Childbirth and tuberculosis, 75. 

Childhood the great danger period, 
24, 49. 

Children, clothing for, 64; cold 
sponging for, 64; delicate should 
not be forced, 68; exercise and 
recreation for, 63; food for, 59; 
open-air schools for, 67; safe- 
guards for, 57; should be 
shielded from all ills, 65. 

Chills and chilliness, as danger 
signals, 106; treatment of, 343. 

Climate, 170, 286-335; a builder 
of general resistance, 295; and 
common sense, 286; and en- 
vironment, a hint on combining 
change of, 292 ; and sleepless- 
ness, 391; attributes of health- 
ful, 300; a valuable adjunct, 
290 ; common experiences prove 
value of, 287; desert, 311; 
duration of stay in new, 294, 
305; effect of, 295; folly to 
depend on alone, 289; general 
effect of, 295; home, on re- 
maining in, 295; how to gain 
full value from, 334; how to 
live in new, 314; how to make 
change of, 315, 328; is it 
specific?, 296; local effect of, 
297; moderately relaxing, 307; 
moderately stimulating, 307; no 
perfect, 315 ; not a direct antidote, 
295; ocean, 308; old belief ex- 
ploded, 295; on fitting to case, 
302, 312 ; primary and secondary 
characteristics of, 300; relapses 
not usually due to return to old, 
294; relaxing, 303; risks of 
changing, 305; stimulating, 303; 
suitable often near, 332; truth 
about, 286; types of, 301; value 
of, 22, 286, 290; who should 
seek change of?, 290. 
Climatic change, circumstances 
that justify, 332; desirability of 
frequent, 331; of changing from 
a good climate, 294; questions 
to study regarding, 290. 
Climatic pessimism, 286; worship, 

286. 
Climatic treatment foreshadowed, 

19. 
Clinical tuberculosis, 51, 101. 
Closed tuberculosis, 86. 
Clothing, for children, 64; for 

outdoor living, 279. 
Coddling, should avoid in protect- 
ing child, 58. 
Ccd-liver oil, 238. 



Coffee, 252; decaffeinized, 253; 
substitutes, 253. 

Cold applications, 398, 449; in 
hemorrhage, 356. 

Colds and catarrh, 108; and res- 
piratory disorders, how to 
avoid, 458; as danger signals, 
108; importance of rest during, 
195; may not be what they 
seem, 109, 110; prevention of, 
350; significance of, 109, 110, 
186, 349, 406; treatment of, 
195. 

Compresses, 398; cold throat, 450. 

Concealment, harm from, 141; no 
longer tolerated, 29, 116. 

Conclusions, false, 114. 

Constipation and its treatment, 
379. 

Consumption, distinction between 
tuberculosis and, 19, 88, 99; 
galloping or hasty, 52, 124; 
means advanced tuberculosis, 
99 ; means tuberculosis plus 
mixed infection, 88; miners', 
90. 

Contrast between normal and 
tuberculous lung, 82. 

Control, regaining a slow process, 
401. 

Convalescence, hidden menace of, 
26; retarded, from other dis- 
eases, a danger signal, 103. 

Cough, absent in early cases, 106; 
a danger signal, 107; control 
and voice control, 345 ; treat- 
ment of, 344-349; voluntary 
control of, 199, 344. 

Country air, advantages of, 265; 
early faith in, 19. 

Course of tuberculosis, 112, 158. 

Curability of tuberculosis, 16, 31; 
impossibility of foretelling, 176; 
relation of cures to, 32 ; wrong 
impressions concerning, 31. 

Cure, apparent, definition of, 452; 

vs. arrestment, 452. 
Cures, per cent of, in early cases, 
32; vaunted, where to obtain 
facts regarding, 159. 
Curtains, suggestions regarding, 
273. 



Danger period, childhood the great, 

211; in convalescence, 26, 28, 

208, 210-211. 
Danger signals, 104-11. 
Death rates, 33; reduced but still 

a peril, 33. 
Deep breathing, question of, 218. 
Defenses of body, 40. 
Developed tuberculosis, 51 (See 

also evident, manifest, and 

clinical tuberculosis). 
Diagnosis, 99-134; association as 

a factor in, 103; importance of 

early, 16, 17, 18, 28, 33-36, 



INDEX 



465 



154; on making your own, 130; 
personal history as a factor in, 
103; preferably made before 
bacilli appear, 127; retarded 
convalescence from other ills as 
a factor in, 103. 

Diarrhea and its treatment, 377. 

Diet, 222-254; for acidity, 374; 
for constipation, 380; for 
diarrhea, 377; for vomiting,, 371; 
in fever, 238, 339; in hemor- 
rhage, 356; in refractory cases, 
444. 

Dietary, importance of balancing, 
226; misconceptions, 246; re- 
stricted, 251; Russell, 433; 
should be simple, 226; trans- 
gressions, 245. 

Digestive disturbances, 366-387. 

Discharges, importance of destroy- 
ing all, 78. 

Diseases to avoid, 43, 65. 

Disinfection of apartments, 79. 

Distinction, between infection and 
disease, 101; between tubercu- 
losis and consumption, 19, 88, 
99. 

Doctors (See also Physicians) and 
medicine, revulsion against, 25. 

Drip sheet, 449. 

Dry air, advantages of, 297; draw- 
backs of, 276, 298; value of, 
297. 

E 

Eating, alone or in company, 226; 
fads in, 243; importance of 
mastication in, 225; regularity 
in, 225; rules for, 222. 

Eggs, 231. 

El Dorado, search for, 21. 

Enemas, 397. 

Environment, and climatic change, 
293; discussion on, 166; in 
country, 265; mental effect of, 
170. 

Error (See also Pitfalls and Mis- 
takes), of discounting prelimi- 
nary conclusions, 134; of mis- 
taking improvement for recovery, 
138; of following footsteps of 
others, 161, 256-257. 

Evidence, more definite, 107; 
weighing the, 111. 

Evident tuberculosis, 31, 32, 51, 
101. 

Examination, importance of peri- 
odical, 80, 459; repeated often 
required, 128. 

Exercise, 207-221; and recreation 
for children, 63; and rest, 188; 
effect of, 214; excessive, very 
harmful, 207; forms of. 211; 
importance of, 208, 457; im- 
portance of controlling by effect, 
214; injurious effect of, may 
be delayed or never evident, 213 ; 
instructions for, 211, 212; 
30 



judicious and violent, contrasted, 
69; less important in certain 
cases, 211; none when sputum 
is bloody, 214; of lungs, 218; 
on alternate days, 444; precau- 
tions concerning, for certain 
patients, 215; promotes recovery, 
209; regularity of, 213; should 
be gradual, 212-213; the great 
reconstructor, 207; untoward ef- 
fect of, 214; value of, recog- 
nized, 22; walking most suitable, 
211. 

Expectoration (See also Sputum), 
a danger signal, 108; continues 
after healing, 182; posture as 
aid to, 345; to loosen, 346; to 
reduce, 348. 

Expert on tuberculosis, how to 
recognize, 144; importance of 
consulting an, 135-143. 

F 

Facts, and figures, 30; importance 
of facing, 155 ; why everyone 
should know, 15. 

Failure, causes of, 17, 19, 20, 21, 
22, 35, 257; past does not 
presage present, 403. 

False economy to use half- 
measures, 163. 

Fatality of tuberculosis, 32, 35, 
114. 

Fatigue, importance of anticipat- 
ing, 194. 

Fats and oils, 237. 

Fear, antidotes for, 400; excessive, 
of tuberculosis, 48-49, 56; of 
moist air, 266; of night air, 
266; of rest, 201. 

Fever, a danger signal, 106; diet 
in, 238, 339; feelings an un- 
reliable guide to, 132, 193; may 
be absent, 106; rest required 
in absence of, 192; significance 
of, 91, 338, 405; treatment of, 
339. 

Fibroid tuberculosis, 125. 

Food, 222-254; and fever, 238, 
339; containing minerals, 229; 
for hot days, 243, 245; for 
infants, 59; groups, 227-228; 
quantity required, 223; ratio, 
227 

Foods' classification of, 227, 228 
(table); fuel, 227, 235; im- 
portance of eating foods that 
count, 224; in alimentary dis- 
orders, list of good and bad, 
370; pros and cons of everyday, 
230; repair, 227, 230; reserve, 
227. 237. 

Forced feeding, 27, 249; dangers 
of, 27, 248; exceptionally use- 
ful, 250; suggestions for, 250- 
251. 

Forerunners, so-called, mean pres- 
ent tuberculosis, 104. 



466 



INDEX 



Frailties of Nature, 184-185. 

Fresh air (See also Open air), 
255-285; and common sense, 
258, 266; as surrounding 
medium, 262; clues to effect of, 
259; compared to cold bath, 
260; contains few germs, 259; 
day-time apathy regarding, 266; 
effect of, 258 ; effect of breathed- 
in air, 262; everyday experiences 
with, 259; fear of, 265; im- 
portance of, 263; importance 
of living in constantly, 265; 
instructions for living in, 
265; local vs. general effect of, 
261; old and new conceptions 
of, 258; physical vs. chemical 
qualities of, 261; precautions 
for delicate patients regarding, 
267; rational use of, 257; right 
and wrong use of, 256. 

Friends and relatives, suggestions 
to, on helping, 146; in relation 
to climatic change, 292; re- 
sponsibilities of, 145, 157. 

Fruit meal, 246. 

Fruits, 237; harmful effect of, 245; 
how to eat, 246. 

Fumes, harmful, 261, 277. 

Fumigation, 79. 

Future in your hands, 156, 451. 

G 

Galen, virtues of dry air of high 
lands recognized by, 19. 

Gases, harmful, 261, 277. 

Gas symptoms, treatment of, 375. 

General considerations, 15-36. 

Generosity of Nature, 177, 408. 

Germs (See Bacilli). 

Getting-up period, 207. 

Glimpses of many important mat- 
ters, 15-36. 

Growing worse in order to get 
better, 91. 

Gymnastic exercises, 218. 



Habit, a loathsome, 62 ; alcohol, 
72; tobacco, 72. 

Habits, importance of regular, 72. 

Half-measures, a false economy, 
163. 

Hasty consumption, 52, 124. 

Healing, 174-187; analogies to, in 
horticulture, 178 ; a slow process, 
171-173, 174, 404, 452; by cav- 
ity-formation, 181; by destruction 
of germs, 176; by lime deposit, 
180; by pleurisy, 83, 176, 178; 
by scar-formation, 176; by sep- 
aration of tissues, 405 ; effort re- 
quired for complete, 175; odd 
accompaniments of, 404; of 
cavity, 181; often incomplete, 
183; of tuberculosis contrasted 
with other diseases, 174; partial 
often spontaneous, 175; time re- 



quired for, 171-173, 174, 404, 
452. 

Healing pains, 95, 407. 

Health, no royal road to, 29. 

Health measures, relative im- 
portance of, 165. 

Heart, effect of lung tuberculosis 
on, 84, 98. 

Heart-beat, noticeable or rapid, a 
danger signal, 106-107. 

Heartburn, treatment of, 373. 

Heating and lighting methods, 
276. 

Hemorrhage, 351-361; a danger 
signal, 110; and altitude, 304; 
a note of cheer regarding, 352, 
353, 359; congestive, 194, 358; 
definition of, 351; duration of 
rest after, 357; erroneous views 
on, 111, 531; may occur with- 
out cough, 110; recurrent, 359; 
pneumothorax treatment of, 358; 
prevention of, 361; treatment 
of, 352 ; usually ceases spon- 
taneously, 352 ; vicarious at 
menstrual period, 111. 

Heredity, bogy of, 403; effect of, 
44-48, 102; important lesson 
from, 48; salutary effect of, 45. 

Hippocrates, advanced views of, 
19. 

Hoarseness, a danger signal, 108, 
123; voice rest in, 199. 

Hope, always ground for, 17; mis- 
placed, a cause of failure, 18. 

Household remedies and measures, 
394. 

How Nature overdoes things, 179. 

How others have come back, 420, 
460. 

How tuberculosis, begins, 101; 
impairs health, 91. 

How tuberculous lungs differ from 
the healthy lungs, 82. 

Humidities recommended. 276. 

Humidity, some desirable, 275, 
298-299. 



Ice-cream and ices, 234. 

Ice-water, 254. 

If the chest had a window, 82-98. 

"I-K," 430. 

Ills to avoid, 43, 65. 

Immunity, definition of. 425 ; 
remedies for passive, 430; types 
of, 425. 

Importance, of early treatment, 16, 
17, 18, 28, 3*3-36, 154; of 
period of seasoning, 210; of 
protecting digestive organs, 222 ; 
of respecting limitations, 162, 
215, 451, 460. 

Improvement, alternating with re- 
lapses, 158; odd accompani- 
ments of, 94, 404; sometimes 
disguised, 92, 404. 

Incipient tuberculosis, definition 



INDEX 



467 



of, 101; not negligible, 36, 101 
(See also Importance of early 
treatment). 

Infection, definition of, 39; dis- 
tinction between disease and. 51, 
101; frequency of, 100; result 
of. 50 ; usually occurs in child- 
hood. 49. 

Information, where to obtain, re- 
garding free treatment. 165; in- 
stitutions, 328; open-air schools, 
67; physicians, 145. 

Inhalations, 347. 

Inheritance, 44-48 ; casting aside 
of belief in, 24. 

Injections, rectal, 397. 

Investigation of case, elements of 
thorough, 127. 



Kindred diseases, 88. 

Knowledge, the key to victory, 16; 

makes outlook more hopeful, 

154. 



Labor, child, 68. 

Latent tuberculosis, 51, 87. 

Legumes, 234. 

Lentils, 234. 

Life-regulators, 229. 

Light treatment, artificial, 285, 
432; natural, 282-285. 

Limitations, importance of re- 
specting. 162, 215, 451, 460. 

Living with tuberculosis, 451. 

Loss of weight (See Weight). 

"Lumpy jaw," 89. 

Lung substance contains few 
sensory nerve fibres, 94. 

Lymphatic system. 41. 

Lymph glands, 41 ; tuberculosis 
of, 51, 431, 432, 433. 

M 

Manifest tuberculosis (See also 
Evident, and Clinical tubercu- 
losis), 31, 32. 

Marquesans, virulence of tubercu- 
losis in, 45. 

Marriage and tuberculosis, 73. 

Massage, abdominal, 382; general, 
198, 399. 

Mastication, importance of, 226. 

Meal, on skipping, 239, 242; the 
heaviest, 242. 

Meats, 230. 

Mechanical disturbances, 98. 

Medicine, appropriate often life- 
saving, 162, 438. # 

Menstrual period, importance of 
rest at, 196. 

Menstrual temperature, 133. 

Mental vs. physical effort, 70, 455. 

Methods of treatment, 160. 

Milk, and milks, 132; condensed, 



60, 61; cow's. 59; dried, 60. 61; 
effect of heat on, 60 ; evaporated, 
60, 61; goat's, 59; how to take, 
233; modified, 232; mother's, 
59 ; pasteurization of, 60 ; source 
and care of, 60; substitutes for 
mother's, 59-60. 

"Milk cure," 247. 

Milk-egg mixture, special, 25. 

Milk products, 234. 

Minerals in food, 229. 

Mistakes, of past, 18; of patients 
in relations with physician, 149 ; 
often less harmful than worry 
over them, 153. 

Mixed infection, 88. 

Moist applications, 445. 

Moisture, in air, some desirable, 
275. 

N 

Nature's compensation, 83; frail- 
ties, 183; generosity, 177, 408; 
handiwork, 83 ; methods, 92, 
176; prodigality, 179; remedies. 
161. 

Nausea and its treatment, 371. 

Nerve-fag, a danger signal, 105. 

Nerve-supply of lungs, 94. 

Nervousness, and its treatment, 
393; climate for, 305; rest in, 
203. 

Nervous system, effects of tuber- 
culosis on, 93. 

Neuritis, 97. 

"Never too late," 17, 36, 155, 
156, 403, 420. 

Nose an inefficient sentinel, 264. 

Nurse, 336; practical vs. trained, 
337. 

Nursing and relief of symptoms, 
336-399. 

Nuts, 235; as sources of oils, 238, 
of protein, 235. 



Occupation, choice of, 70, 454. 

Old beliefs, 18. 

Oleomargarine, 238. 

Olive oil, 238. 

Open and closed tuberculosis, 85. 

Open air (See Air and Fresh air). 

Operations, 438 ; when pneu- 
mothorax is impracticable, 439, 
442. 

Optimism, advantage of, 155. 

Other ills may indicate tubercu- 
losis, 103. 

Other organs, effect of tubercu- 
losis of lungs on, 83; time re- 
quired for recuperation of, 452. 

Outdoor living, abuse of, 256; as 
preventive, 63 ; importance of, 
after recovery, 453; introduction 
of, 20; not synonymous with 
roughing it. 256. 

Outdoor sleeping, aids to comfort 
in, 297; quarters, 270. 



468 



INDEX 



Outlook for advance in treatment, 

436. 
Overeating (See Forced feeding). 
Overstudy, dangers of, 69. 



Pain, 94; a danger signal, 107; 
healing, 95, 407; in lungs, why 
uncommon, 94; referred, 95; 
shoulder and arm, 96; shoulder 
and chest, 107; weather, 97, 
407. 

Paradox of curability and fatality, 
16. 

Pasteurization, 60. 

Pastimes (See Amusements). 

"Patent" medicines and "Cures,' ' 
157. 

Patience brings its reward, 174. 

Patient, entitled to truth, 141; 
mistakes of, in relation with 
physician, 149; should cooperate 
fully, 153. 

Peas, 234. 

Periodicity of symptoms, 92, 109, 
110, 112, 114, 115, 116, 134, 
158, 175, 183, 187, 404, 406. 

Personal history, as diagnostic 
aid, 103. 

Pessimism, may be changed to 
optimism, 156. 

Pessimists may win, 156. 

Physician, a valuable asset, 162 
and patient, 135-153; glad to 
grant reasonable requests, 152 
handicaps of, in tuberculosis 
135; how to help your, 149; 
importance of choosing carefully, 
135, 143; of cooperating with L 
153; procedure of, 127; you 
and your, 135-153. 

Physicians, how misled regarding 
tuberculosis, 137 ; inadequacy 
of training and opportunities for 
study of tuberculosis, 137; op- 
posing views of, 136. 

Pitfalls. 114. 

Planning your recovery. 154-173. 

Pleura, thickened, 83, 179, 189. 

Pleural adhesions, 83, 179, 189; 
operations for, 442; prevent 
pneumothorax, 441. 

Pleural effusions, 179, 190, 363. 

Pleurisy, a danger signal, 110; 
salutary effect of, 83, 178, 190; 
treatment of, 361. 

Pneumothorax, in hemorrhage, 358; 
operations, when impracticable, 
439, 442; spontaneous, 190, 
440; treatment, 439-442. 

Poisons, effect of, 91; released 
when bacilli die, 92; three 
sources of, 91. 

Postural rest, 197; an aid to ex- 
pectoration, 345; on worst side, 
197. 

Precautions, for certain patients, 
215, 267; for sick, 75; necessary 
at all ages, 54; need for 



special, 75; simple may save 

many a heartache, 55, 57. 
Preconceived ideas should be laid 

aside, 99. 
Predisposing influences, 43. 
Predisposition may be inherited, 

24, 44. 
Pregnancy and tuberculosis, 73. 
Prevalence, facts and figures on, 

30. 
Prevention, 55-81; of colds, 350, 

430; of hemorrhage, 361; of 

stomach and bowel disorders, 

367. 
Preventive vaccination, 53, 79. 
Preventives for fear and dread, 

400. 
Prophesy, futility of, 176. 
Proteins, 230; harm from eating' 

too freely, 245. 
Puberty a time for special care, 

58. 

B 

Radium in treatment, 431. 

Recognition of tuberculosis, 99- 
134 (See also Diagnosis). 

Refractory cases, suggestions for, 
442. 

Relapses, alternating with im- 
provement (See also Periodicity 
of symptoms), 158; due to re- 
turn to old habits, 294; how to 
prevent, 183. 

Remedies, for passive immuniza- 
tion, 430; importance of fitting 
to case, 161, 437, 438; other, 
436. 

Repair, Nature's methods of, 176 
(See also Healing). 

[Resistance, factors that reduce, 
44; increased by germ destruc- 
tion, 43; inherent, 40. 

Resolution, to make, 169. 

Resorts, climatic, 314-327. 

Rest, 188-207; absolute, 442; a 
relative factor, 191 ; as an aid 
to digestion, 198; at menstrual 
period, 196, 361; duration of, 
205, 207; effect of, 188; ex- 
cessive, does no great harm, 207 ; 
fear of, 201; for accumulating, 
reserve energy, 194; for colds, 
195; for rapid heart, 196; how 
to obtain complete, 196; in 
absence of fever, 192 ; in 
fatigue, 193; in fever, 192, 339; 
in fever from any cause, 193; 
in hemorrhage, 194; instructions 
for, 190; mistakes regarding, 
201; of voice, 198, 345; on 
Sundays, 456; postural, on 
worst side, 197; postural, to 
assist expectoration, 345; rules 
for, 192; sexual, 200; value first 
recognized, 22; value of, 189- 
190; vs. nervousness and the 
"blues," 202; why necessary, 
188. 



INDEX 



469 



Rest hour, 198; importance of 
observing indefinitely, 215. 

Rest program, how to modify, 207 ; 
modification of, 204, 206. 

Roof, double, 273. 

Roughage, value of in diet, 236. 

Roughing-it, dangers of, 22, 256, 
273. 

Rules for eating, 222. 

Run-down condition, a danger sig- 
nal, 105. 

s 

Sacrifice, usually required, 29, 
164. 

Safeguards for children, 57. 

Sanatorium, question, various 
angles of, 167-170; the first, 
20. 

Scars not firm for years, 452. 

School, a mistake to force delicate 
child in, 68; days, 67. 

Schools, open-air, 67. 

Scrofula (See also Tuberculosis of 
glands), 52. 

Sea voyages, 310. 

Seeds of tuberculosis, 23, 37; 
and soil, 24, 37; usually im- 
planted in childhood, 24. 53. 

Separation from sick essential, 62, 
270. 

Seriousness of tuberculosis, 32, 
114. 

Sexual rest, 200. 

Significance, of retarded recovery 
from other ills, 103; of tubercu- 
losis in family, 102. 

Signs, of tuberculosis, 104-111; 
and accompaniments of healing, 
83, 95, 404. 

Silence in treatment, 198; for re- 
fractory cases, 443; indications 
for, 198. 

Six-hour vs. 16-hour man, 190. 

Sleeping, open-air, practical hints 
on. 277. 

Sleeping quarters, 270. 

Sleeplessness, effect of climate on, 
391; treatment of, 387. 

Soil, a factor in acquirement of 
tuberculosis, 24, 37; influences 
that render fertile, 43. 

Sour stomach, treatment of, 373. 

Specialist (See Expert). 

Special methods, 425-450. 

Spirochete, Castellini's, 89. 

Sponging in fever, 339, 447; in 
childhood, 64. 

Sports, hazards of violent, 69-70. 

Spread of tuberculosis, 37-54. 

Sputum, absence of, 108; care of, 
76; < formation continues after 
healing, 182; involuntary swal- 
lowing of, 108; make-up of, 408; 
raised without cough, 108 ; risks 
of swallowing, 76, 367 (See also 
Expectoration). 



Starches, 235; should not eat too 
many at one meal, 237. 

Statistics, 30. 

Stomach and bowel disturbances, 
366-387; frequent in lung tuber- 
culosis, 366; prevention of, 367. 

Stomach, on respecting feelings of, 
225. 

Strain, as cause of tuberculosis, 
104. 

Streptothrix infection, 89. 

Structural alterations caused by 
tuberculosis, 82-98. 

"Stuffing evil," 248 (See also 
Forced feeding). 

Stupes, 398. 

Suggestions, for refractory cases, 
442; to friends on helping, 146; 
to those of limited means, 145, 
164, 291. 

Sun bath, 282-285. 

Sunlight, a germicide, 40; effect 
of, 281; in throat tuberculosis, 
285. 

Surf-bathing, a warning, 309. 

Surgical measures, 438. 

Sweating, a danger signal, 106; 
treatment of, 341-343. 

Sweets and fruits, 237. 

Symptom, definition of, 101. 

Symptoms, 104-111; first usually 
subside, 113 ; referred, sym- 
pathetic and misleading, 92, 93, 
94, 95, 98, 104, 122; repeated 
outbreaks or periodicity of, 92, 
109, 110, 112, 113, 114, 115, 
116, 134, 158, 175, 183, 187, 
404, 406; throat, in lung tuber- 
culosis, 108-110, 119, 122, 344; 
treatment of, 336-399. 

Syphilis of lung, 89-90. 

T 

Tea, 252. 

Tell-tale signs, 110. 

Temperature, of air, mistakes con- 
cerning, 274; menstrual rise in, 
133; normal, 132; of body, and 
resistance, 274 ; recommendations 
on, 275; variation at life 
extremes, 133. 

Tents and tent-houses, 171. 

Terms, misleading, 56, 114, 115, 
139 ; responsibility of friends 
for, 145. 

Testimonials, why unreliable, 158. 

Thermometer, importance of, 193; 
use of, 132. 

Thinness may be favorable, 402. 

"Those who live in glass houses," 
56. 

Throat, clearing of, a danger sig- 
nal, 107-108; cold compress 
for, 450; importance of care 
of, 42 ; of throat, nose and 
mouth, 65; symptoms, relation- 
ship to lung tuberculosis, 344. 



470 



INDEX 



Time, great importance of, 171 ; on 
avoiding a set limit, 172; re- 
quired, 171, 452; the true 
healer, 171. 

Tonsils, really lymph glands, 41; 
treatment of disease, 66. 

Transmission of tuberculosis, child- 
hood usual age for, 24, 49; no 
danger of during quiet breath- 
ing, or in closed case, or by 
careful patient, 49; slight dan- 
ger from casual association, 48 ; 
usually a slow process, 48. 

Treatment, essence of, 29; im- 
portance of early, 16, 17, 18, 28. 
33-36, 154; methods of, 160; of 
special symptoms, 336-399; 
open-air treatment foreshadowed, 
19; postural, 183, 345; proof 
of necessity for, 183. 

Trudeau, founds sanatorium at 
Saranac, 21. 

Truth vital to patient, 141. 

Tubercle, 84; appearance of, 86; 
evolution of, 84, 87 ; recogni- 
tion of importance of, 23. 

Tubercle bacilli (See Bacilli). 

Tuberculin, rise and fall and re- 
vival of, 25; test, 129; treat- 
ment, a key to, 186 — full dis- 
cussion of, 427-429. 

Tuberculosis, advanced, picture of, 
99; early, does not show in 
appearance, 99 ; irregular course 
of, 101; of bones and joints, 
52, 431, 432; of bowels, 366; 
of glands, 51, 431, 432; of 
throat, 285; seriousness of, 32; 
transmitted to animals, 23. 

Tuberculous lung, close-up view of, 
84. 



Vacation-taking, 68, 71, 456. 

Vaccination, preventive, 53, 79. 

Vaccines, 430. 

Vagus nerve, 94. 

Vegetables, 236; supplementary 

function of, 236; three classes 

of, 236. 
Vegetarianism, 243. 
Ventilation, hints on, 268. 



Victim, average one per family, 

31; careful vs. careless, 29, 155; 

lack of consideration for, 19 ; no 

longer an outcast, 155. 
Views of tuberculosis, erroneous, 

136; modern, 28; opposing, 136^ -^ 
Virulence of tuberculosis in primi* : •• 

tive peoples, 45. 
Vitamines, 229; injured by heat, * 

60. 
Vocational training, 216. 
Voice, loss or weakness of, a! 

danger signal, 108, 122; rest 

of, 198, 443. 
Vomiting and its treatment, 371. 
Voyage of health often rough, 404. 

w 

Wading-in vs. bold plunge, 164, 

203. 
Waiting to make sure, 134. 
Walking, instructions for, 211; 

less important in some cases, 

211; the best exercise. 211. 
Wanderlust, warning against, 333. 
Warmth and resistance, 274. 
Warnings, suggestive, 105. 
Water, requirements, 252. 
Water-drinking at meal-time, 253; 

in fever, 252. 
"Water on chest," 179, 190, 363. 
Weighing the evidence, 111. 
Weight, discussion on, 222-223; 

loss of, a danger signal, 106; 

treatment of loss of, 214, 444. 
Wet jacket, 450. 
Wet-nurse, 59. 
"White swelling," 52. 
Why everyone does not acquire 

tuberculosis 39. 
Work, choice of, 70, 454; how to 

begin, 456; when to resume, 

451. 
"Work cure," 216. 
Worries, remedies for, 400. 
"Worrying hour," 230. 
Wrecking of a race, 45. 



X-ray, in diagnosis, 129; in treat- 
ment, 431. 



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